Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT INT RX4.0X22 INT40022UX

Facility

$3,250.00

Hospital Charge Code	270651072C
Hospital Revenue Code	278
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$786.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

STENT INT RX4.0X22 INT40022UX

Facility

$3,250.00

Hospital Charge Code	270651072C
Hospital Revenue Code	278
Min. Negotiated Rate	$78.33
Max. Negotiated Rate	$1,625.00
Rate for Payer: Aetna Commercial	$1,235.00
Rate for Payer: Aetna Medicare Advantage	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.75
Rate for Payer: Cigna Commercial	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50
Rate for Payer: UnitedHealthcare Community & State	$78.33
Rate for Payer: Wellpoint Medicaid Managed Care	$86.12

STENT INT RX4.0X26 INT40026UX

Facility

$3,250.00

Hospital Charge Code	270651073C
Hospital Revenue Code	278
Min. Negotiated Rate	$78.33
Max. Negotiated Rate	$1,625.00
Rate for Payer: Aetna Commercial	$1,235.00
Rate for Payer: Aetna Medicare Advantage	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.75
Rate for Payer: Cigna Commercial	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50
Rate for Payer: UnitedHealthcare Community & State	$78.33
Rate for Payer: Wellpoint Medicaid Managed Care	$86.12

STENT INT RX4.0X26 INT40026UX

Facility

$3,250.00

Hospital Charge Code	270651073C
Hospital Revenue Code	278
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$786.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

STENT INT RX4.0X30 INT40030UX

Facility

$3,250.00

Hospital Charge Code	270651074C
Hospital Revenue Code	278
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$786.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

STENT INT RX4.0X30 INT40030UX

Facility

$3,250.00

Hospital Charge Code	270651074C
Hospital Revenue Code	278
Min. Negotiated Rate	$78.33
Max. Negotiated Rate	$1,625.00
Rate for Payer: Aetna Commercial	$1,235.00
Rate for Payer: Aetna Medicare Advantage	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.75
Rate for Payer: Cigna Commercial	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50
Rate for Payer: UnitedHealthcare Community & State	$78.33
Rate for Payer: Wellpoint Medicaid Managed Care	$86.12

STENT INT RX4.0X9 INT40009UX

Facility

$3,250.00

Hospital Charge Code	270651068C
Hospital Revenue Code	278
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$786.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

STENT INT RX4.0X9 INT40009UX

Facility

$3,250.00

Hospital Charge Code	270651068C
Hospital Revenue Code	278
Min. Negotiated Rate	$78.33
Max. Negotiated Rate	$1,625.00
Rate for Payer: Aetna Commercial	$1,235.00
Rate for Payer: Aetna Medicare Advantage	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.75
Rate for Payer: Cigna Commercial	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50
Rate for Payer: UnitedHealthcare Community & State	$78.33
Rate for Payer: Wellpoint Medicaid Managed Care	$86.12

STENT KIT 7FR X 5CM (PIGTAIL

Facility

$635.00

Hospital Charge Code	270330640
Hospital Revenue Code	278
Min. Negotiated Rate	$95.25
Max. Negotiated Rate	$153.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$139.70
Rate for Payer: Qualcare PPO/HMO/WC	$95.25

STENT KIT 7FR X 5CM (PIGTAIL

Facility

$635.00

Hospital Charge Code	270330640
Hospital Revenue Code	278
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$317.50
Rate for Payer: Aetna Commercial	$241.30
Rate for Payer: Aetna Medicare Advantage	$190.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$161.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$161.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$161.93
Rate for Payer: Cigna Commercial	$317.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$139.70
Rate for Payer: Qualcare PPO/HMO/WC	$95.25
Rate for Payer: UnitedHealthcare Community & State	$15.30
Rate for Payer: Wellpoint Medicaid Managed Care	$16.83

STENT KIT ADVANIX STR 5FR 4CM

Facility

$852.15

Service Code	HCPCS C2625
Hospital Charge Code	270677007
Hospital Revenue Code	278
Min. Negotiated Rate	$127.82
Max. Negotiated Rate	$206.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$206.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.47
Rate for Payer: Qualcare PPO/HMO/WC	$127.82

STENT KIT ADVANIX STR 5FR 4CM

Facility

$852.15

Service Code	HCPCS C2625
Hospital Charge Code	270677007
Hospital Revenue Code	278
Min. Negotiated Rate	$20.54
Max. Negotiated Rate	$426.07
Rate for Payer: Aetna Commercial	$323.82
Rate for Payer: Aetna Medicare Advantage	$255.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$217.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$217.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$217.30
Rate for Payer: Cigna Commercial	$426.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$206.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.47
Rate for Payer: Qualcare PPO/HMO/WC	$127.82
Rate for Payer: UnitedHealthcare Community & State	$20.54
Rate for Payer: Wellpoint Medicaid Managed Care	$22.58

STENT KITS 10FR 5CM PIGTAIL

Facility

$756.00

Hospital Charge Code	270330641
Hospital Revenue Code	272
Min. Negotiated Rate	$18.22
Max. Negotiated Rate	$378.00
Rate for Payer: Aetna Commercial	$287.28
Rate for Payer: Aetna Medicare Advantage	$226.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$192.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$192.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$192.78
Rate for Payer: Cigna Commercial	$378.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$226.80
Rate for Payer: Oxford Commercial	$151.20
Rate for Payer: Qualcare PPO/HMO/WC	$113.40
Rate for Payer: UnitedHealthcare Commercial	$151.20
Rate for Payer: UnitedHealthcare Community & State	$18.22
Rate for Payer: Wellpoint Medicaid Managed Care	$20.03

STENT KITS 10FR 5CM PIGTAIL

Facility

$756.00

Hospital Charge Code	270330641
Hospital Revenue Code	272
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$113.40
Rate for Payer: Qualcare PPO/HMO/WC	$113.40

STENT LD ILIAC/10MMX25MMX135CM

Facility

$5,957.00

Hospital Charge Code	2709007134
Hospital Revenue Code	272
Min. Negotiated Rate	$143.56
Max. Negotiated Rate	$2,978.50
Rate for Payer: Aetna Commercial	$2,263.66
Rate for Payer: Aetna Medicare Advantage	$1,787.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,519.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,519.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,519.04
Rate for Payer: Cigna Commercial	$2,978.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,787.10
Rate for Payer: Oxford Commercial	$1,191.40
Rate for Payer: Qualcare PPO/HMO/WC	$893.55
Rate for Payer: UnitedHealthcare Commercial	$1,191.40
Rate for Payer: UnitedHealthcare Community & State	$143.56
Rate for Payer: Wellpoint Medicaid Managed Care	$157.86

STENT LD ILIAC/10MMX25MMX135CM

Facility

$5,957.00

Hospital Charge Code	2709007134
Hospital Revenue Code	272
Min. Negotiated Rate	$893.55
Max. Negotiated Rate	$893.55
Rate for Payer: Qualcare PPO/HMO/WC	$893.55

STENT LD/ILIAC/10MMX37MMX135CM

Facility

$6,417.00

Hospital Charge Code	2709007135
Hospital Revenue Code	272
Min. Negotiated Rate	$154.65
Max. Negotiated Rate	$3,208.50
Rate for Payer: Aetna Commercial	$2,438.46
Rate for Payer: Aetna Medicare Advantage	$1,925.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,636.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,636.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,636.34
Rate for Payer: Cigna Commercial	$3,208.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,925.10
Rate for Payer: Oxford Commercial	$1,283.40
Rate for Payer: Qualcare PPO/HMO/WC	$962.55
Rate for Payer: UnitedHealthcare Commercial	$1,283.40
Rate for Payer: UnitedHealthcare Community & State	$154.65
Rate for Payer: Wellpoint Medicaid Managed Care	$170.05

STENT LD/ILIAC/10MMX37MMX135CM

Facility

$6,417.00

Hospital Charge Code	2709007135
Hospital Revenue Code	272
Min. Negotiated Rate	$962.55
Max. Negotiated Rate	$962.55
Rate for Payer: Qualcare PPO/HMO/WC	$962.55

STENT LIB 2 75x24 389342427

Facility

$4,375.00

Hospital Charge Code	270638556C
Hospital Revenue Code	278
Min. Negotiated Rate	$105.44
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,662.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$962.50
Rate for Payer: Qualcare PPO/HMO/WC	$656.25
Rate for Payer: UnitedHealthcare Community & State	$105.44
Rate for Payer: Wellpoint Medicaid Managed Care	$115.94

STENT LIB 2 75x24 389342427

Facility

$4,375.00

Hospital Charge Code	270638556C
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$962.50
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

STENT LIB 2.75x24 389342427

Facility

$1,250.00

Hospital Charge Code	270638556
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

STENT LIB 2.75x24 389342427

Facility

$1,250.00

Hospital Charge Code	270638556
Hospital Revenue Code	278
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

STENT LIB 2.75x28 389342827

Facility

$4,375.00

Hospital Charge Code	270638905
Hospital Revenue Code	278
Min. Negotiated Rate	$105.44
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,662.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$962.50
Rate for Payer: Qualcare PPO/HMO/WC	$656.25
Rate for Payer: UnitedHealthcare Community & State	$105.44
Rate for Payer: Wellpoint Medicaid Managed Care	$115.94

STENT LIB 2.75x28 389342827

Facility

$4,375.00

Hospital Charge Code	270638905
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$962.50
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

STENT LIB 3.5x24 389342435

Facility

$4,375.00

Hospital Charge Code	270639211C
Hospital Revenue Code	278
Min. Negotiated Rate	$105.44
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,662.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$962.50
Rate for Payer: Qualcare PPO/HMO/WC	$656.25
Rate for Payer: UnitedHealthcare Community & State	$105.44
Rate for Payer: Wellpoint Medicaid Managed Care	$115.94

Know your out-of-pocket cost for care.

All Charges