Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT CK URET 6F 22-32 03660

Facility

$458.45

Service Code	HCPCS C2617
Hospital Charge Code	270621488
Hospital Revenue Code	278
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$229.22
Rate for Payer: Aetna Commercial	$174.21
Rate for Payer: Aetna Medicare Advantage	$137.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$116.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$116.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$116.90
Rate for Payer: Cigna Commercial	$229.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$100.86
Rate for Payer: Qualcare PPO/HMO/WC	$68.77
Rate for Payer: UnitedHealthcare Community & State	$11.05
Rate for Payer: Wellpoint Medicaid Managed Care	$12.15

STENT CK URET PGTL 6 28 036628

Facility

$431.60

Hospital Charge Code	270626553
Hospital Revenue Code	278
Min. Negotiated Rate	$64.74
Max. Negotiated Rate	$104.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$86.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$94.95
Rate for Payer: Qualcare PPO/HMO/WC	$64.74

STENT CK URET PGTL 6 28 036628

Facility

$431.60

Hospital Charge Code	270626553
Hospital Revenue Code	278
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$215.80
Rate for Payer: Aetna Commercial	$164.01
Rate for Payer: Aetna Medicare Advantage	$129.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$86.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.06
Rate for Payer: Cigna Commercial	$215.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$94.95
Rate for Payer: Qualcare PPO/HMO/WC	$64.74
Rate for Payer: UnitedHealthcare Community & State	$10.40
Rate for Payer: Wellpoint Medicaid Managed Care	$11.44

STENT CK URET PGTL 7 24 036724

Facility

$432.85

Hospital Charge Code	270625205
Hospital Revenue Code	278
Min. Negotiated Rate	$64.93
Max. Negotiated Rate	$104.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$86.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$95.23
Rate for Payer: Qualcare PPO/HMO/WC	$64.93

STENT CK URET PGTL 7 24 036724

Facility

$432.85

Hospital Charge Code	270625205
Hospital Revenue Code	278
Min. Negotiated Rate	$10.43
Max. Negotiated Rate	$216.43
Rate for Payer: Aetna Commercial	$164.48
Rate for Payer: Aetna Medicare Advantage	$129.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$86.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.38
Rate for Payer: Cigna Commercial	$216.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$95.23
Rate for Payer: Qualcare PPO/HMO/WC	$64.93
Rate for Payer: UnitedHealthcare Community & State	$10.43
Rate for Payer: Wellpoint Medicaid Managed Care	$11.47

STENT COLONIC 27/22 6X230 6510

Facility

$12,975.00

Service Code	HCPCS C1876
Hospital Charge Code	270643471
Hospital Revenue Code	278
Min. Negotiated Rate	$312.70
Max. Negotiated Rate	$6,487.50
Rate for Payer: Aetna Commercial	$4,930.50
Rate for Payer: Aetna Medicare Advantage	$3,892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,308.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,308.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,308.62
Rate for Payer: Cigna Commercial	$6,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,139.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,854.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,946.25
Rate for Payer: UnitedHealthcare Community & State	$312.70
Rate for Payer: Wellpoint Medicaid Managed Care	$343.84

STENT COLONIC 27/22 6X230 6510

Facility

$12,975.00

Service Code	HCPCS C1876
Hospital Charge Code	270643471
Hospital Revenue Code	278
Min. Negotiated Rate	$1,946.25
Max. Negotiated Rate	$3,139.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,139.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,854.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,946.25

STENT COMPLETE SE LONG SC6100

Facility

$6,250.00

Hospital Charge Code	270CH0125
Hospital Revenue Code	278
Min. Negotiated Rate	$150.62
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$150.62
Rate for Payer: Wellpoint Medicaid Managed Care	$165.62

STENT COMPLETE SE LONG SC6100

Facility

$6,250.00

Hospital Charge Code	270CH0125
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

STENT COMPLETE SE LONG SC640L

Facility

$6,250.00

Hospital Charge Code	270CH0126
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

STENT COMPLETE SE LONG SC640L

Facility

$6,250.00

Hospital Charge Code	270CH0126
Hospital Revenue Code	278
Min. Negotiated Rate	$150.62
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$150.62
Rate for Payer: Wellpoint Medicaid Managed Care	$165.62

STENT COMPLETE SE LONG SC660L

Facility

$6,250.00

Hospital Charge Code	270CH0127
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

STENT COMPLETE SE LONG SC660L

Facility

$6,250.00

Hospital Charge Code	270CH0127
Hospital Revenue Code	278
Min. Negotiated Rate	$150.62
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$150.62
Rate for Payer: Wellpoint Medicaid Managed Care	$165.62

STENT COMPLETE SE LONG SC660LV

Facility

$6,250.00

Hospital Charge Code	2709006904
Hospital Revenue Code	272
Min. Negotiated Rate	$150.62
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.00
Rate for Payer: Oxford Commercial	$1,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Commercial	$1,250.00
Rate for Payer: UnitedHealthcare Community & State	$150.62
Rate for Payer: Wellpoint Medicaid Managed Care	$165.62

STENT COMPLETE SE LONG SC660LV

Facility

$6,250.00

Hospital Charge Code	2709006904
Hospital Revenue Code	272
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$937.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

STENT COMPLETE SE LONG SC680L

Facility

$6,250.00

Hospital Charge Code	270CH0128
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

STENT COMPLETE SE LONG SC680L

Facility

$6,250.00

Hospital Charge Code	270CH0128
Hospital Revenue Code	278
Min. Negotiated Rate	$150.62
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$150.62
Rate for Payer: Wellpoint Medicaid Managed Care	$165.62

STENT COMPLETE SE LONG SC680LV

Facility

$6,250.00

Hospital Charge Code	2709006905
Hospital Revenue Code	272
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$937.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

STENT COMPLETE SE LONG SC680LV

Facility

$6,250.00

Hospital Charge Code	2709006905
Hospital Revenue Code	272
Min. Negotiated Rate	$150.62
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.00
Rate for Payer: Oxford Commercial	$1,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Commercial	$1,250.00
Rate for Payer: UnitedHealthcare Community & State	$150.62
Rate for Payer: Wellpoint Medicaid Managed Care	$165.62

STENT COMPLETE SE LONG SC7100

Facility

$6,250.00

Hospital Charge Code	270CH0129
Hospital Revenue Code	278
Min. Negotiated Rate	$150.62
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$150.62
Rate for Payer: Wellpoint Medicaid Managed Care	$165.62

STENT COMPLETE SE LONG SC7100

Facility

$6,250.00

Hospital Charge Code	270CH0129
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

STENT COMPLETE SE LONG SC7100L

Facility

$6,250.00

Hospital Charge Code	2709006906
Hospital Revenue Code	272
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$937.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

STENT COMPLETE SE LONG SC7100L

Facility

$6,250.00

Hospital Charge Code	2709006906
Hospital Revenue Code	272
Min. Negotiated Rate	$150.62
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.00
Rate for Payer: Oxford Commercial	$1,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Commercial	$1,250.00
Rate for Payer: UnitedHealthcare Community & State	$150.62
Rate for Payer: Wellpoint Medicaid Managed Care	$165.62

STENT COMPLETE SE LONG SC740L

Facility

$6,250.00

Hospital Charge Code	270CH0130
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

STENT COMPLETE SE LONG SC740L

Facility

$6,250.00

Hospital Charge Code	270CH0130
Hospital Revenue Code	278
Min. Negotiated Rate	$150.62
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$150.62
Rate for Payer: Wellpoint Medicaid Managed Care	$165.62

Know your out-of-pocket cost for care.

All Charges