Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT DOUBLE PIGTAIL SZ 7-5

Facility

$266.50

Hospital Charge Code	270673442
Hospital Revenue Code	278
Min. Negotiated Rate	$6.42
Max. Negotiated Rate	$133.25
Rate for Payer: Aetna Commercial	$101.27
Rate for Payer: Aetna Medicare Advantage	$79.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.96
Rate for Payer: Cigna Commercial	$133.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$58.63
Rate for Payer: Qualcare PPO/HMO/WC	$39.98
Rate for Payer: UnitedHealthcare Community & State	$6.42
Rate for Payer: Wellpoint Medicaid Managed Care	$7.06

STENT DOUBLE PIGTAIL SZ 7-5

Facility

$266.50

Hospital Charge Code	270673442
Hospital Revenue Code	278
Min. Negotiated Rate	$39.98
Max. Negotiated Rate	$64.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$58.63
Rate for Payer: Qualcare PPO/HMO/WC	$39.98

STENT DRUG ELUTING 2.25 /9 MM

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700909
Hospital Revenue Code	278
Min. Negotiated Rate	$54.23
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Community & State	$54.23
Rate for Payer: Wellpoint Medicaid Managed Care	$59.62

STENT DRUG ELUTING 2.25 /9 MM

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700909
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DRUG ELUTING 2.25 /9 MM

Facility

$2,250.00

Hospital Charge Code	2700909
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DRUG ELUTING 2.25 /9 MM

Facility

$2,250.00

Hospital Charge Code	2700909
Hospital Revenue Code	278
Min. Negotiated Rate	$54.23
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Community & State	$54.23
Rate for Payer: Wellpoint Medicaid Managed Care	$59.62

STENT DRUG ELUTING 2.25/9 MM

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700909S
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DRUG ELUTING 2.25/9 MM

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700909S
Hospital Revenue Code	278
Min. Negotiated Rate	$54.23
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Community & State	$54.23
Rate for Payer: Wellpoint Medicaid Managed Care	$59.62

STENT DRUG-ELUT PERIPH 6x100MM

Facility

$8,975.00

Service Code	HCPCS C1874
Hospital Charge Code	270675417
Hospital Revenue Code	278
Min. Negotiated Rate	$216.30
Max. Negotiated Rate	$4,487.50
Rate for Payer: Aetna Commercial	$3,410.50
Rate for Payer: Aetna Medicare Advantage	$2,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,288.62
Rate for Payer: Cigna Commercial	$4,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,974.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25
Rate for Payer: UnitedHealthcare Community & State	$216.30
Rate for Payer: Wellpoint Medicaid Managed Care	$237.84

STENT DRUG-ELUT PERIPH 6x100MM

Facility

$8,975.00

Service Code	HCPCS C1874
Hospital Charge Code	270675417
Hospital Revenue Code	278
Min. Negotiated Rate	$1,346.25
Max. Negotiated Rate	$2,171.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,974.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25

STENT DRUG-ELUT PERIPH 6x40MM

Facility

$5,875.00

Hospital Charge Code	270675419
Hospital Revenue Code	278
Min. Negotiated Rate	$141.59
Max. Negotiated Rate	$2,937.50
Rate for Payer: Aetna Commercial	$2,232.50
Rate for Payer: Aetna Medicare Advantage	$1,762.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,498.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,498.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,498.12
Rate for Payer: Cigna Commercial	$2,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,421.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,292.50
Rate for Payer: Qualcare PPO/HMO/WC	$881.25
Rate for Payer: UnitedHealthcare Community & State	$141.59
Rate for Payer: Wellpoint Medicaid Managed Care	$155.69

STENT DRUG-ELUT PERIPH 6x40MM

Facility

$5,875.00

Hospital Charge Code	270675419
Hospital Revenue Code	278
Min. Negotiated Rate	$881.25
Max. Negotiated Rate	$1,421.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,421.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,292.50
Rate for Payer: Qualcare PPO/HMO/WC	$881.25

STENT DRUG-ELUT PERIPH 6x60MM

Facility

$7,475.00

Service Code	HCPCS C1874
Hospital Charge Code	270675418
Hospital Revenue Code	278
Min. Negotiated Rate	$1,121.25
Max. Negotiated Rate	$1,808.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,808.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,644.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25

STENT DRUG-ELUT PERIPH 6x60MM

Facility

$7,475.00

Service Code	HCPCS C1874
Hospital Charge Code	270675418
Hospital Revenue Code	278
Min. Negotiated Rate	$180.15
Max. Negotiated Rate	$3,737.50
Rate for Payer: Aetna Commercial	$2,840.50
Rate for Payer: Aetna Medicare Advantage	$2,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,906.12
Rate for Payer: Cigna Commercial	$3,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,808.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,644.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25
Rate for Payer: UnitedHealthcare Community & State	$180.15
Rate for Payer: Wellpoint Medicaid Managed Care	$198.09

STENT DRUG-ELUT PERIPH 6x80MM

Facility

$8,975.00

Hospital Charge Code	270667654
Hospital Revenue Code	278
Min. Negotiated Rate	$216.30
Max. Negotiated Rate	$4,487.50
Rate for Payer: Aetna Commercial	$3,410.50
Rate for Payer: Aetna Medicare Advantage	$2,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,288.62
Rate for Payer: Cigna Commercial	$4,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,974.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25
Rate for Payer: UnitedHealthcare Community & State	$216.30
Rate for Payer: Wellpoint Medicaid Managed Care	$237.84

STENT DRUG-ELUT PERIPH 6x80MM

Facility

$8,975.00

Hospital Charge Code	270667654
Hospital Revenue Code	278
Min. Negotiated Rate	$1,346.25
Max. Negotiated Rate	$2,171.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,974.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25

STENT EMBOL PIPLINE 4X12MM

Facility

$89,300.00

Service Code	HCPCS C1884
Hospital Charge Code	270696541S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,152.13
Max. Negotiated Rate	$44,650.00
Rate for Payer: Aetna Commercial	$33,934.00
Rate for Payer: Aetna Medicare Advantage	$26,790.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,771.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,771.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,860.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22,771.50
Rate for Payer: Cigna Commercial	$44,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,610.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19,646.00
Rate for Payer: Qualcare PPO/HMO/WC	$13,395.00
Rate for Payer: UnitedHealthcare Community & State	$2,152.13
Rate for Payer: Wellpoint Medicaid Managed Care	$2,366.45

STENT EMBOL PIPLINE 4X12MM

Facility

$89,300.00

Service Code	HCPCS C1884
Hospital Charge Code	270696541S
Hospital Revenue Code	278
Min. Negotiated Rate	$13,395.00
Max. Negotiated Rate	$21,610.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,610.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19,646.00
Rate for Payer: Qualcare PPO/HMO/WC	$13,395.00

STENT ENDOMAXX 23MM 120 MM

Facility

$14,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270688794
Hospital Revenue Code	278
Min. Negotiated Rate	$337.40
Max. Negotiated Rate	$7,000.00
Rate for Payer: Aetna Commercial	$5,320.00
Rate for Payer: Aetna Medicare Advantage	$4,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,570.00
Rate for Payer: Cigna Commercial	$7,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,080.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00
Rate for Payer: UnitedHealthcare Community & State	$337.40
Rate for Payer: Wellpoint Medicaid Managed Care	$371.00

STENT ENDOMAXX 23MM 120 MM

Facility

$14,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270688794
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$3,388.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,080.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00

STENT ENDOMAXX 23MM 150 MM

Facility

$14,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270688795
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$3,388.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,080.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00

STENT ENDOMAXX 23MM 150 MM

Facility

$14,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270688795
Hospital Revenue Code	278
Min. Negotiated Rate	$337.40
Max. Negotiated Rate	$7,000.00
Rate for Payer: Aetna Commercial	$5,320.00
Rate for Payer: Aetna Medicare Advantage	$4,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,570.00
Rate for Payer: Cigna Commercial	$7,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,080.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00
Rate for Payer: UnitedHealthcare Community & State	$337.40
Rate for Payer: Wellpoint Medicaid Managed Care	$371.00

STENT ENDOPROSTH GFT 8X7.6MM

Facility

$19,230.00

Service Code	HCPCS C1874
Hospital Charge Code	270689581S
Hospital Revenue Code	278
Min. Negotiated Rate	$463.44
Max. Negotiated Rate	$9,615.00
Rate for Payer: Aetna Commercial	$7,307.40
Rate for Payer: Aetna Medicare Advantage	$5,769.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,903.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,903.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,846.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,903.65
Rate for Payer: Cigna Commercial	$9,615.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,653.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,230.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,884.50
Rate for Payer: UnitedHealthcare Community & State	$463.44
Rate for Payer: Wellpoint Medicaid Managed Care	$509.60

STENT ENDOPROSTH GFT 8X7.6MM

Facility

$19,230.00

Service Code	HCPCS C1874
Hospital Charge Code	270689581S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,884.50
Max. Negotiated Rate	$4,653.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,846.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,653.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,230.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,884.50

STENT ENDOPYELOTOMY RETROMAX

Facility

$990.00

Hospital Charge Code	270655402
Hospital Revenue Code	278
Min. Negotiated Rate	$23.86
Max. Negotiated Rate	$495.00
Rate for Payer: Aetna Commercial	$376.20
Rate for Payer: Aetna Medicare Advantage	$297.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$198.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.45
Rate for Payer: Cigna Commercial	$495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$239.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$217.80
Rate for Payer: Qualcare PPO/HMO/WC	$148.50
Rate for Payer: UnitedHealthcare Community & State	$23.86
Rate for Payer: Wellpoint Medicaid Managed Care	$26.23

Know your out-of-pocket cost for care.

All Charges