Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT MCV BILI 10.0F 10CM 3932

Facility

$760.00

Service Code	HCPCS C2625
Hospital Charge Code	270617759
Hospital Revenue Code	278
Min. Negotiated Rate	$18.32
Max. Negotiated Rate	$380.00
Rate for Payer: Aetna Commercial	$288.80
Rate for Payer: Aetna Medicare Advantage	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$152.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$193.80
Rate for Payer: Cigna Commercial	$380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$167.20
Rate for Payer: Qualcare PPO/HMO/WC	$114.00
Rate for Payer: UnitedHealthcare Community & State	$18.32
Rate for Payer: Wellpoint Medicaid Managed Care	$20.14

STENT MCV BILI 10.0F 5CM 3930

Facility

$760.00

Hospital Charge Code	270617760
Hospital Revenue Code	278
Min. Negotiated Rate	$18.32
Max. Negotiated Rate	$380.00
Rate for Payer: Aetna Commercial	$288.80
Rate for Payer: Aetna Medicare Advantage	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$152.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$193.80
Rate for Payer: Cigna Commercial	$380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$167.20
Rate for Payer: Qualcare PPO/HMO/WC	$114.00
Rate for Payer: UnitedHealthcare Community & State	$18.32
Rate for Payer: Wellpoint Medicaid Managed Care	$20.14

STENT MCV BILI 10.0F 5CM 3930

Facility

$760.00

Hospital Charge Code	270617760
Hospital Revenue Code	278
Min. Negotiated Rate	$114.00
Max. Negotiated Rate	$183.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$152.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$167.20
Rate for Payer: Qualcare PPO/HMO/WC	$114.00

STENT MCV BILI 10.0F 7CM 3931

Facility

$760.00

Hospital Charge Code	270617758
Hospital Revenue Code	278
Min. Negotiated Rate	$114.00
Max. Negotiated Rate	$183.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$152.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$167.20
Rate for Payer: Qualcare PPO/HMO/WC	$114.00

STENT MCV BILI 10.0F 7CM 3931

Facility

$760.00

Hospital Charge Code	270617758
Hospital Revenue Code	278
Min. Negotiated Rate	$18.32
Max. Negotiated Rate	$380.00
Rate for Payer: Aetna Commercial	$288.80
Rate for Payer: Aetna Medicare Advantage	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$152.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$193.80
Rate for Payer: Cigna Commercial	$380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$167.20
Rate for Payer: Qualcare PPO/HMO/WC	$114.00
Rate for Payer: UnitedHealthcare Community & State	$18.32
Rate for Payer: Wellpoint Medicaid Managed Care	$20.14

STENT MCV BILI 7.0F 5CM 3920

Facility

$760.00

Hospital Charge Code	270617753
Hospital Revenue Code	278
Min. Negotiated Rate	$18.32
Max. Negotiated Rate	$380.00
Rate for Payer: Aetna Commercial	$288.80
Rate for Payer: Aetna Medicare Advantage	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$152.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$193.80
Rate for Payer: Cigna Commercial	$380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$167.20
Rate for Payer: Qualcare PPO/HMO/WC	$114.00
Rate for Payer: UnitedHealthcare Community & State	$18.32
Rate for Payer: Wellpoint Medicaid Managed Care	$20.14

STENT MCV BILI 7.0F 5CM 3920

Facility

$760.00

Hospital Charge Code	270617753
Hospital Revenue Code	278
Min. Negotiated Rate	$114.00
Max. Negotiated Rate	$183.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$152.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$167.20
Rate for Payer: Qualcare PPO/HMO/WC	$114.00

STENT MCV BILI 7.0F 7CM 3921

Facility

$760.00

Service Code	HCPCS C2625
Hospital Charge Code	270617754
Hospital Revenue Code	278
Min. Negotiated Rate	$114.00
Max. Negotiated Rate	$183.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$152.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$167.20
Rate for Payer: Qualcare PPO/HMO/WC	$114.00

STENT MCV BILI 7.0F 7CM 3921

Facility

$760.00

Service Code	HCPCS C2625
Hospital Charge Code	270617754
Hospital Revenue Code	278
Min. Negotiated Rate	$18.32
Max. Negotiated Rate	$380.00
Rate for Payer: Aetna Commercial	$288.80
Rate for Payer: Aetna Medicare Advantage	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$152.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$193.80
Rate for Payer: Cigna Commercial	$380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$167.20
Rate for Payer: Qualcare PPO/HMO/WC	$114.00
Rate for Payer: UnitedHealthcare Community & State	$18.32
Rate for Payer: Wellpoint Medicaid Managed Care	$20.14

STENT MCV BILI 8.5F 10CM 3927

Facility

$760.00

Hospital Charge Code	270617756
Hospital Revenue Code	278
Min. Negotiated Rate	$18.32
Max. Negotiated Rate	$380.00
Rate for Payer: Aetna Commercial	$288.80
Rate for Payer: Aetna Medicare Advantage	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$152.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$193.80
Rate for Payer: Cigna Commercial	$380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$167.20
Rate for Payer: Qualcare PPO/HMO/WC	$114.00
Rate for Payer: UnitedHealthcare Community & State	$18.32
Rate for Payer: Wellpoint Medicaid Managed Care	$20.14

STENT MCV BILI 8.5F 10CM 3927

Facility

$760.00

Hospital Charge Code	270617756
Hospital Revenue Code	278
Min. Negotiated Rate	$114.00
Max. Negotiated Rate	$183.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$152.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$167.20
Rate for Payer: Qualcare PPO/HMO/WC	$114.00

STENT MCV BILI 8.5F 5CM 3925

Facility

$760.00

Hospital Charge Code	270617757
Hospital Revenue Code	278
Min. Negotiated Rate	$114.00
Max. Negotiated Rate	$183.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$152.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$167.20
Rate for Payer: Qualcare PPO/HMO/WC	$114.00

STENT MCV BILI 8.5F 5CM 3925

Facility

$760.00

Hospital Charge Code	270617757
Hospital Revenue Code	278
Min. Negotiated Rate	$18.32
Max. Negotiated Rate	$380.00
Rate for Payer: Aetna Commercial	$288.80
Rate for Payer: Aetna Medicare Advantage	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$152.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$193.80
Rate for Payer: Cigna Commercial	$380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$167.20
Rate for Payer: Qualcare PPO/HMO/WC	$114.00
Rate for Payer: UnitedHealthcare Community & State	$18.32
Rate for Payer: Wellpoint Medicaid Managed Care	$20.14

STENT MCV BILI 8.5F 7CM 3926

Facility

$760.00

Hospital Charge Code	270617755
Hospital Revenue Code	278
Min. Negotiated Rate	$114.00
Max. Negotiated Rate	$183.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$152.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$167.20
Rate for Payer: Qualcare PPO/HMO/WC	$114.00

STENT MCV BILI 8.5F 7CM 3926

Facility

$760.00

Hospital Charge Code	270617755
Hospital Revenue Code	278
Min. Negotiated Rate	$18.32
Max. Negotiated Rate	$380.00
Rate for Payer: Aetna Commercial	$288.80
Rate for Payer: Aetna Medicare Advantage	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$152.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$193.80
Rate for Payer: Cigna Commercial	$380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$167.20
Rate for Payer: Qualcare PPO/HMO/WC	$114.00
Rate for Payer: UnitedHealthcare Community & State	$18.32
Rate for Payer: Wellpoint Medicaid Managed Care	$20.14

STENT MCV CONTOR 6X22 18022101

Facility

$1,149.65

Hospital Charge Code	270615912
Hospital Revenue Code	278
Min. Negotiated Rate	$172.45
Max. Negotiated Rate	$278.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$229.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$252.92
Rate for Payer: Qualcare PPO/HMO/WC	$172.45

STENT MCV CONTOR 6X22 18022101

Facility

$1,149.65

Hospital Charge Code	270615912
Hospital Revenue Code	278
Min. Negotiated Rate	$27.71
Max. Negotiated Rate	$574.83
Rate for Payer: Aetna Commercial	$436.87
Rate for Payer: Aetna Medicare Advantage	$344.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$229.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.16
Rate for Payer: Cigna Commercial	$574.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$252.92
Rate for Payer: Qualcare PPO/HMO/WC	$172.45
Rate for Payer: UnitedHealthcare Community & State	$27.71
Rate for Payer: Wellpoint Medicaid Managed Care	$30.47

STENT MCV CONTOR 6X24 18022201

Facility

$1,149.65

Service Code	HCPCS C1876
Hospital Charge Code	270615913
Hospital Revenue Code	278
Min. Negotiated Rate	$172.45
Max. Negotiated Rate	$278.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$229.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$252.92
Rate for Payer: Qualcare PPO/HMO/WC	$172.45

STENT MCV CONTOR 6X24 18022201

Facility

$1,149.65

Service Code	HCPCS C1876
Hospital Charge Code	270615913
Hospital Revenue Code	278
Min. Negotiated Rate	$27.71
Max. Negotiated Rate	$574.83
Rate for Payer: Aetna Commercial	$436.87
Rate for Payer: Aetna Medicare Advantage	$344.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$229.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.16
Rate for Payer: Cigna Commercial	$574.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$252.92
Rate for Payer: Qualcare PPO/HMO/WC	$172.45
Rate for Payer: UnitedHealthcare Community & State	$27.71
Rate for Payer: Wellpoint Medicaid Managed Care	$30.47

STENT MCV CONTOR 6X26 18022301

Facility

$1,149.65

Hospital Charge Code	270615914
Hospital Revenue Code	278
Min. Negotiated Rate	$172.45
Max. Negotiated Rate	$278.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$229.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$252.92
Rate for Payer: Qualcare PPO/HMO/WC	$172.45

STENT MCV CONTOR 6X26 18022301

Facility

$1,149.65

Hospital Charge Code	270615914
Hospital Revenue Code	278
Min. Negotiated Rate	$27.71
Max. Negotiated Rate	$574.83
Rate for Payer: Aetna Commercial	$436.87
Rate for Payer: Aetna Medicare Advantage	$344.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$229.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.16
Rate for Payer: Cigna Commercial	$574.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$252.92
Rate for Payer: Qualcare PPO/HMO/WC	$172.45
Rate for Payer: UnitedHealthcare Community & State	$27.71
Rate for Payer: Wellpoint Medicaid Managed Care	$30.47

STENT MCV ESOPH 16F 1310

Facility

$5,443.25

Hospital Charge Code	270617890
Hospital Revenue Code	278
Min. Negotiated Rate	$131.18
Max. Negotiated Rate	$2,721.62
Rate for Payer: Aetna Commercial	$2,068.43
Rate for Payer: Aetna Medicare Advantage	$1,632.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,388.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,388.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,088.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,388.03
Rate for Payer: Cigna Commercial	$2,721.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,317.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,197.52
Rate for Payer: Qualcare PPO/HMO/WC	$816.49
Rate for Payer: UnitedHealthcare Community & State	$131.18
Rate for Payer: Wellpoint Medicaid Managed Care	$144.25

STENT MCV ESOPH 16F 1310

Facility

$5,443.25

Hospital Charge Code	270617890
Hospital Revenue Code	278
Min. Negotiated Rate	$816.49
Max. Negotiated Rate	$1,317.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,088.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,317.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,197.52
Rate for Payer: Qualcare PPO/HMO/WC	$816.49

STENT MCV PERC 6 80 160-205

Facility

$960.00

Hospital Charge Code	270626530
Hospital Revenue Code	278
Min. Negotiated Rate	$23.14
Max. Negotiated Rate	$480.00
Rate for Payer: Aetna Commercial	$364.80
Rate for Payer: Aetna Medicare Advantage	$288.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$244.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$244.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$192.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$244.80
Rate for Payer: Cigna Commercial	$480.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$211.20
Rate for Payer: Qualcare PPO/HMO/WC	$144.00
Rate for Payer: UnitedHealthcare Community & State	$23.14
Rate for Payer: Wellpoint Medicaid Managed Care	$25.44

STENT MCV PERC 6 80 160-205

Facility

$960.00

Hospital Charge Code	270626530
Hospital Revenue Code	278
Min. Negotiated Rate	$144.00
Max. Negotiated Rate	$232.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$192.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$211.20
Rate for Payer: Qualcare PPO/HMO/WC	$144.00

Know your out-of-pocket cost for care.

All Charges