Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT FLEXIMA URETERAL 8 X 24

Facility

$952.75

Service Code	HCPCS C2617
Hospital Charge Code	270661633N
Hospital Revenue Code	278
Min. Negotiated Rate	$22.96
Max. Negotiated Rate	$476.38
Rate for Payer: Aetna Commercial	$362.05
Rate for Payer: Aetna Medicare Advantage	$285.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.95
Rate for Payer: Cigna Commercial	$476.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$209.60
Rate for Payer: Qualcare PPO/HMO/WC	$142.91
Rate for Payer: UnitedHealthcare Community & State	$22.96
Rate for Payer: Wellpoint Medicaid Managed Care	$25.25

STENT FLEXIMA URETERAL 8 X 24

Facility

$952.75

Service Code	HCPCS C2617
Hospital Charge Code	270661633N
Hospital Revenue Code	278
Min. Negotiated Rate	$142.91
Max. Negotiated Rate	$230.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$209.60
Rate for Payer: Qualcare PPO/HMO/WC	$142.91

STENT FLEXIMA URETERAL 8 X 24

Facility

$952.75

Service Code	HCPCS C2617
Hospital Charge Code	270661633S
Hospital Revenue Code	278
Min. Negotiated Rate	$142.91
Max. Negotiated Rate	$230.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$209.60
Rate for Payer: Qualcare PPO/HMO/WC	$142.91

STENT FLEXIMA URETERAL 8 X 24

Facility

$952.75

Service Code	HCPCS C2617
Hospital Charge Code	270661633
Hospital Revenue Code	278
Min. Negotiated Rate	$22.96
Max. Negotiated Rate	$476.38
Rate for Payer: Aetna Commercial	$362.05
Rate for Payer: Aetna Medicare Advantage	$285.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.95
Rate for Payer: Cigna Commercial	$476.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$209.60
Rate for Payer: Qualcare PPO/HMO/WC	$142.91
Rate for Payer: UnitedHealthcare Community & State	$22.96
Rate for Payer: Wellpoint Medicaid Managed Care	$25.25

STENT FLEXIMA URETERAL 8 X 24

Facility

$952.75

Service Code	HCPCS C2617
Hospital Charge Code	270661633
Hospital Revenue Code	278
Min. Negotiated Rate	$142.91
Max. Negotiated Rate	$230.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$209.60
Rate for Payer: Qualcare PPO/HMO/WC	$142.91

STENT FLUENCY PLUS 10x60

Facility

$2,714.00

Hospital Charge Code	270634920
Hospital Revenue Code	278
Min. Negotiated Rate	$65.41
Max. Negotiated Rate	$1,357.00
Rate for Payer: Aetna Commercial	$1,031.32
Rate for Payer: Aetna Medicare Advantage	$814.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$692.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$692.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$542.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$692.07
Rate for Payer: Cigna Commercial	$1,357.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$656.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$597.08
Rate for Payer: Qualcare PPO/HMO/WC	$407.10
Rate for Payer: UnitedHealthcare Community & State	$65.41
Rate for Payer: Wellpoint Medicaid Managed Care	$71.92

STENT FLUENCY PLUS 10x60

Facility

$2,714.00

Hospital Charge Code	270634920
Hospital Revenue Code	278
Min. Negotiated Rate	$407.10
Max. Negotiated Rate	$656.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$542.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$656.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$597.08
Rate for Payer: Qualcare PPO/HMO/WC	$407.10

STENT FLUENCY PLUS 10X60

Facility

$13,570.00

Hospital Charge Code	2709003570
Hospital Revenue Code	272
Min. Negotiated Rate	$327.04
Max. Negotiated Rate	$6,785.00
Rate for Payer: Aetna Commercial	$5,156.60
Rate for Payer: Aetna Medicare Advantage	$4,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,460.35
Rate for Payer: Cigna Commercial	$6,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,071.00
Rate for Payer: Oxford Commercial	$2,714.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50
Rate for Payer: UnitedHealthcare Commercial	$2,714.00
Rate for Payer: UnitedHealthcare Community & State	$327.04
Rate for Payer: Wellpoint Medicaid Managed Care	$359.61

STENT FLUENCY PLUS 10X60

Facility

$13,570.00

Hospital Charge Code	2709003570
Hospital Revenue Code	272
Min. Negotiated Rate	$2,035.50
Max. Negotiated Rate	$2,035.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

STENT FLUENCY PLUS 8 X 60 X 8

Facility

$15,715.00

Service Code	HCPCS C1874
Hospital Charge Code	270637894
Hospital Revenue Code	278
Min. Negotiated Rate	$2,357.25
Max. Negotiated Rate	$3,803.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,143.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,803.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,457.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,357.25

STENT FLUENCY PLUS 8 X 60 X 8

Facility

$15,715.00

Service Code	HCPCS C1874
Hospital Charge Code	270637894
Hospital Revenue Code	278
Min. Negotiated Rate	$378.73
Max. Negotiated Rate	$7,857.50
Rate for Payer: Aetna Commercial	$5,971.70
Rate for Payer: Aetna Medicare Advantage	$4,714.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,007.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,007.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,143.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,007.32
Rate for Payer: Cigna Commercial	$7,857.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,803.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,457.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,357.25
Rate for Payer: UnitedHealthcare Community & State	$378.73
Rate for Payer: Wellpoint Medicaid Managed Care	$416.45

STENT FLUENCY PLUS 8 X 60 X 80

Facility

$15,715.00

Service Code	HCPCS C1876
Hospital Charge Code	270637894S
Hospital Revenue Code	278
Min. Negotiated Rate	$378.73
Max. Negotiated Rate	$7,857.50
Rate for Payer: Aetna Commercial	$5,971.70
Rate for Payer: Aetna Medicare Advantage	$4,714.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,007.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,007.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,143.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,007.32
Rate for Payer: Cigna Commercial	$7,857.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,803.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,457.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,357.25
Rate for Payer: UnitedHealthcare Community & State	$378.73
Rate for Payer: Wellpoint Medicaid Managed Care	$416.45

STENT FLUENCY PLUS 8 X 60 X 80

Facility

$15,715.00

Service Code	HCPCS C1876
Hospital Charge Code	270637894S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,357.25
Max. Negotiated Rate	$3,803.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,143.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,803.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,457.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,357.25

STENT FLUENCY PLUS 8X60X80

Facility

$13,570.00

Hospital Charge Code	2709003571
Hospital Revenue Code	272
Min. Negotiated Rate	$2,035.50
Max. Negotiated Rate	$2,035.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

STENT FLUENCY PLUS 8X60X80

Facility

$13,570.00

Hospital Charge Code	2709003571
Hospital Revenue Code	272
Min. Negotiated Rate	$327.04
Max. Negotiated Rate	$6,785.00
Rate for Payer: Aetna Commercial	$5,156.60
Rate for Payer: Aetna Medicare Advantage	$4,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,460.35
Rate for Payer: Cigna Commercial	$6,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,071.00
Rate for Payer: Oxford Commercial	$2,714.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50
Rate for Payer: UnitedHealthcare Commercial	$2,714.00
Rate for Payer: UnitedHealthcare Community & State	$327.04
Rate for Payer: Wellpoint Medicaid Managed Care	$359.61

STENT FULLY COVERD 100

Facility

$14,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270678265
Hospital Revenue Code	272
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$2,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00

STENT FULLY COVERD 100

Facility

$14,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270678265
Hospital Revenue Code	272
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) PPO	$3,570.00
Rate for Payer: Cigna Commercial	$7,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,200.00
Rate for Payer: Oxford Commercial	$2,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00
Rate for Payer: UnitedHealthcare Commercial	$2,800.00
Rate for Payer: UnitedHealthcare Community & State	$337.40
Rate for Payer: Wellpoint Medicaid Managed Care	$371.00

STENT FULLY COVERED .035 X 100

Facility

$14,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270688581
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 FULLY COVERED .035 X 100

Facility

$14,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270688581
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 GEENEN PANCRE 5X7 GEPD57

Facility

$572.30

Hospital Charge Code	270637519
Hospital Revenue Code	278
Min. Negotiated Rate	$13.79
Max. Negotiated Rate	$286.15
Rate for Payer: Aetna Commercial	$217.47
Rate for Payer: Aetna Medicare Advantage	$171.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$145.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$145.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$114.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$145.94
Rate for Payer: Cigna Commercial	$286.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$125.91
Rate for Payer: Qualcare PPO/HMO/WC	$85.84
Rate for Payer: UnitedHealthcare Community & State	$13.79
Rate for Payer: Wellpoint Medicaid Managed Care	$15.17

STENT GEENEN PANCRE 5X7 GEPD57

Facility

$572.30

Hospital Charge Code	270637519
Hospital Revenue Code	278
Min. Negotiated Rate	$85.84
Max. Negotiated Rate	$138.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$114.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$125.91
Rate for Payer: Qualcare PPO/HMO/WC	$85.84

STENT GEN 6x15 135cm PG1560BAX

Facility

$7,375.00

Hospital Charge Code	270637225C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,106.25
Max. Negotiated Rate	$1,784.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,784.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,622.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,106.25

STENT GEN 6x15 135cm PG1560BAX

Facility

$7,375.00

Hospital Charge Code	270637225C
Hospital Revenue Code	278
Min. Negotiated Rate	$177.74
Max. Negotiated Rate	$3,687.50
Rate for Payer: Aetna Commercial	$2,802.50
Rate for Payer: Aetna Medicare Advantage	$2,212.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,880.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,880.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,880.62
Rate for Payer: Cigna Commercial	$3,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,784.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,622.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,106.25
Rate for Payer: UnitedHealthcare Community & State	$177.74
Rate for Payer: Wellpoint Medicaid Managed Care	$195.44

STENT GEN 6X18 80 PG1860BSS

Facility

$6,944.00

Hospital Charge Code	270624012
Hospital Revenue Code	278
Min. Negotiated Rate	$1,041.60
Max. Negotiated Rate	$1,680.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,388.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,680.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,527.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.60

STENT GEN 6X18 80 PG1860BSS

Facility

$6,944.00

Hospital Charge Code	270624012V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,041.60
Max. Negotiated Rate	$1,680.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,388.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,680.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,527.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.60

Know your out-of-pocket cost for care.

All Charges