Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT LIBERTE 3 5X12 389351235

Facility

$4,340.00

Hospital Charge Code	270636580C
Hospital Revenue Code	278
Min. Negotiated Rate	$651.00
Max. Negotiated Rate	$1,050.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$868.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$954.80
Rate for Payer: Qualcare PPO/HMO/WC	$651.00

STENT LIBERTE 3 5X12 389351235

Facility

$4,340.00

Hospital Charge Code	270636580C
Hospital Revenue Code	278
Min. Negotiated Rate	$104.59
Max. Negotiated Rate	$2,170.00
Rate for Payer: Aetna Commercial	$1,649.20
Rate for Payer: Aetna Medicare Advantage	$1,302.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,106.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,106.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$868.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,106.70
Rate for Payer: Cigna Commercial	$2,170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$954.80
Rate for Payer: Qualcare PPO/HMO/WC	$651.00
Rate for Payer: UnitedHealthcare Community & State	$104.59
Rate for Payer: Wellpoint Medicaid Managed Care	$115.01

STENT LIBERTE 3.5X12 389351235

Facility

$4,340.00

Hospital Charge Code	270636580
Hospital Revenue Code	278
Min. Negotiated Rate	$104.59
Max. Negotiated Rate	$2,170.00
Rate for Payer: Aetna Commercial	$1,649.20
Rate for Payer: Aetna Medicare Advantage	$1,302.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,106.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,106.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$868.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,106.70
Rate for Payer: Cigna Commercial	$2,170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$954.80
Rate for Payer: Qualcare PPO/HMO/WC	$651.00
Rate for Payer: UnitedHealthcare Community & State	$104.59
Rate for Payer: Wellpoint Medicaid Managed Care	$115.01

STENT LIBERTE 3.5X12 389351235

Facility

$4,340.00

Hospital Charge Code	270636580
Hospital Revenue Code	278
Min. Negotiated Rate	$651.00
Max. Negotiated Rate	$1,050.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$868.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$954.80
Rate for Payer: Qualcare PPO/HMO/WC	$651.00

STENT LIBERTE 3 5x20 389342035

Facility

$4,375.00

Hospital Charge Code	270637881C
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 LIBERTE 3 5x20 389342035

Facility

$4,375.00

Hospital Charge Code	270637881C
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 LIBERTE 4.0x12 389341240

Facility

$4,375.00

Hospital Charge Code	270638226C
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 LIBERTE 4.0x12 389341240

Facility

$4,375.00

Hospital Charge Code	270638226C
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 LIBERTE 4.0X16 389351640

Facility

$4,340.00

Hospital Charge Code	270636694
Hospital Revenue Code	278
Min. Negotiated Rate	$651.00
Max. Negotiated Rate	$1,050.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$868.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$954.80
Rate for Payer: Qualcare PPO/HMO/WC	$651.00

STENT LIBERTE 4.0X16 389351640

Facility

$4,340.00

Hospital Charge Code	270636694
Hospital Revenue Code	278
Min. Negotiated Rate	$104.59
Max. Negotiated Rate	$2,170.00
Rate for Payer: Aetna Commercial	$1,649.20
Rate for Payer: Aetna Medicare Advantage	$1,302.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,106.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,106.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$868.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,106.70
Rate for Payer: Cigna Commercial	$2,170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$954.80
Rate for Payer: Qualcare PPO/HMO/WC	$651.00
Rate for Payer: UnitedHealthcare Community & State	$104.59
Rate for Payer: Wellpoint Medicaid Managed Care	$115.01

STENT LIBERTE 5.0X12MM 3891250

Facility

$4,340.00

Hospital Charge Code	270636555
Hospital Revenue Code	278
Min. Negotiated Rate	$651.00
Max. Negotiated Rate	$1,050.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$868.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$954.80
Rate for Payer: Qualcare PPO/HMO/WC	$651.00

STENT LIBERTE 5.0X12MM 3891250

Facility

$4,340.00

Hospital Charge Code	270636555
Hospital Revenue Code	278
Min. Negotiated Rate	$104.59
Max. Negotiated Rate	$2,170.00
Rate for Payer: Aetna Commercial	$1,649.20
Rate for Payer: Aetna Medicare Advantage	$1,302.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,106.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,106.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$868.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,106.70
Rate for Payer: Cigna Commercial	$2,170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$954.80
Rate for Payer: Qualcare PPO/HMO/WC	$651.00
Rate for Payer: UnitedHealthcare Community & State	$104.59
Rate for Payer: Wellpoint Medicaid Managed Care	$115.01

STENT LIBERTE 5 0x20 389342050

Facility

$8,750.00

Hospital Charge Code	270637673C
Hospital Revenue Code	278
Min. Negotiated Rate	$210.88
Max. Negotiated Rate	$4,375.00
Rate for Payer: Aetna Commercial	$3,325.00
Rate for Payer: Aetna Medicare Advantage	$2,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,231.25
Rate for Payer: Cigna Commercial	$4,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,925.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50
Rate for Payer: UnitedHealthcare Community & State	$210.88
Rate for Payer: Wellpoint Medicaid Managed Care	$231.88

STENT LIBERTE 5 0x20 389342050

Facility

$8,750.00

Hospital Charge Code	270637673C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$2,117.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,925.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50

STENT LIBERTE 5.x20 38934-2050

Facility

$8,750.00

Hospital Charge Code	270637673
Hospital Revenue Code	278
Min. Negotiated Rate	$210.88
Max. Negotiated Rate	$4,375.00
Rate for Payer: Aetna Commercial	$3,325.00
Rate for Payer: Aetna Medicare Advantage	$2,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,231.25
Rate for Payer: Cigna Commercial	$4,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,925.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50
Rate for Payer: UnitedHealthcare Community & State	$210.88
Rate for Payer: Wellpoint Medicaid Managed Care	$231.88

STENT LIBERTE 5.x20 38934-2050

Facility

$8,750.00

Hospital Charge Code	270637673
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$2,117.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,925.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50

STENT LIBERTE MON 4x8 38934840

Facility

$4,375.00

Hospital Charge Code	270638316C
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 LIBERTE MON 4x8 38934840

Facility

$4,375.00

Hospital Charge Code	270638316C
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 LIBERTE MONO 12X27

Facility

$4,200.00

Service Code	HCPCS C1876
Hospital Charge Code	270662857
Hospital Revenue Code	278
Min. Negotiated Rate	$101.22
Max. Negotiated Rate	$2,100.00
Rate for Payer: Aetna Commercial	$1,596.00
Rate for Payer: Aetna Medicare Advantage	$1,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,071.00
Rate for Payer: Cigna Commercial	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,016.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$924.00
Rate for Payer: Qualcare PPO/HMO/WC	$630.00
Rate for Payer: UnitedHealthcare Community & State	$101.22
Rate for Payer: Wellpoint Medicaid Managed Care	$111.30

STENT LIBERTE MONO 12X27

Facility

$4,200.00

Service Code	HCPCS C1876
Hospital Charge Code	270662857
Hospital Revenue Code	278
Min. Negotiated Rate	$630.00
Max. Negotiated Rate	$1,016.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,016.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$924.00
Rate for Payer: Qualcare PPO/HMO/WC	$630.00

STENT LIBERTE MONO 2.75X12MM

Facility

$4,375.00

Hospital Charge Code	270937896
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 LIBERTE MONO 2.75X12MM

Facility

$4,375.00

Hospital Charge Code	270937896
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 LIBERTE MONO 3.5x28mm

Facility

$1,250.00

Hospital Charge Code	270639379
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 LIBERTE MONO 3.5x28mm

Facility

$1,250.00

Hospital Charge Code	270639379
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 LIBERTE MONO 4.0x16mm

Facility

$1,250.00

Hospital Charge Code	270638784
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

Know your out-of-pocket cost for care.

All Charges