Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT MULTI MI 2.5X23 10078223

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643419C
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

STENT MULTI MI 2.5X23 10078223

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643419C
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

STENT MULTIRX 3.0X18 100784818

Facility

$4,875.00

Hospital Charge Code	270643616C
Hospital Revenue Code	278
Min. Negotiated Rate	$117.49
Max. Negotiated Rate	$2,437.50
Rate for Payer: Aetna Commercial	$1,852.50
Rate for Payer: Aetna Medicare Advantage	$1,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,243.12
Rate for Payer: Cigna Commercial	$2,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,072.50
Rate for Payer: Qualcare PPO/HMO/WC	$731.25
Rate for Payer: UnitedHealthcare Community & State	$117.49
Rate for Payer: Wellpoint Medicaid Managed Care	$129.19

STENT MULTIRX 3.0X18 100784818

Facility

$4,875.00

Hospital Charge Code	270643616C
Hospital Revenue Code	278
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$1,179.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,072.50
Rate for Payer: Qualcare PPO/HMO/WC	$731.25

STENT MULTI RX 30x28 10078428

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643618
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

STENT MULTI RX 30x28 10078428

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643618
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

STENT MULTI RX 3.0X8 100784808

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643613C
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

STENT MULTI RX 3.0X8 100784808

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643613C
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

STENT MULT-LK 2.5X18 100782318

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643367C
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

STENT MULT-LK 2.5X18 100782318

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643367C
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

STENT MULT RX 2.75X8 100784708

Facility

$4,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270643417C
Hospital Revenue Code	278
Min. Negotiated Rate	$117.49
Max. Negotiated Rate	$2,437.50
Rate for Payer: Aetna Commercial	$1,852.50
Rate for Payer: Aetna Medicare Advantage	$1,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,243.12
Rate for Payer: Cigna Commercial	$2,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,072.50
Rate for Payer: Qualcare PPO/HMO/WC	$731.25
Rate for Payer: UnitedHealthcare Community & State	$117.49
Rate for Payer: Wellpoint Medicaid Managed Care	$129.19

STENT MULT RX 2.75X8 100784708

Facility

$4,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270643417C
Hospital Revenue Code	278
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$1,179.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,072.50
Rate for Payer: Qualcare PPO/HMO/WC	$731.25

STENT MULT RX 3.0X28 100784828

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643618C
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

STENT MULT RX 3.0X28 100784828

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643618C
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

STENT MULT UL 5.0X13 100338213

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643935C
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

STENT MULT UL 5.0X13 100338213

Facility

$4,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270643935N
Hospital Revenue Code	278
Min. Negotiated Rate	$117.49
Max. Negotiated Rate	$2,437.50
Rate for Payer: Aetna Commercial	$1,852.50
Rate for Payer: Aetna Medicare Advantage	$1,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,243.12
Rate for Payer: Cigna Commercial	$2,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,072.50
Rate for Payer: Qualcare PPO/HMO/WC	$731.25
Rate for Payer: UnitedHealthcare Community & State	$117.49
Rate for Payer: Wellpoint Medicaid Managed Care	$129.19

STENT MULT UL 5.0X13 100338213

Facility

$4,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270643935N
Hospital Revenue Code	278
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$1,179.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,072.50
Rate for Payer: Qualcare PPO/HMO/WC	$731.25

STENT MULT UL 5.0X13 100338213

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643935C
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

STENT MUL ULT 4.5X28 100338128

Facility

$4,875.00

Hospital Charge Code	270643418C
Hospital Revenue Code	278
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$1,179.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,072.50
Rate for Payer: Qualcare PPO/HMO/WC	$731.25

STENT MUL ULT 4.5X28 100338128

Facility

$4,875.00

Hospital Charge Code	270643418C
Hospital Revenue Code	278
Min. Negotiated Rate	$117.49
Max. Negotiated Rate	$2,437.50
Rate for Payer: Aetna Commercial	$1,852.50
Rate for Payer: Aetna Medicare Advantage	$1,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,243.12
Rate for Payer: Cigna Commercial	$2,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,072.50
Rate for Payer: Qualcare PPO/HMO/WC	$731.25
Rate for Payer: UnitedHealthcare Community & State	$117.49
Rate for Payer: Wellpoint Medicaid Managed Care	$129.19

STENT NEPHROSTOMY 8FR 24CM

Facility

$516.25

Service Code	HCPCS C2617
Hospital Charge Code	270665951
Hospital Revenue Code	278
Min. Negotiated Rate	$77.44
Max. Negotiated Rate	$124.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$103.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$113.58
Rate for Payer: Qualcare PPO/HMO/WC	$77.44

STENT NEPHROSTOMY 8FR 24CM

Facility

$516.25

Service Code	HCPCS C2617
Hospital Charge Code	270665951S
Hospital Revenue Code	278
Min. Negotiated Rate	$77.44
Max. Negotiated Rate	$124.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$103.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$113.58
Rate for Payer: Qualcare PPO/HMO/WC	$77.44

STENT NEPHROSTOMY 8FR 24CM

Facility

$516.25

Service Code	HCPCS C2617
Hospital Charge Code	270665951S
Hospital Revenue Code	278
Min. Negotiated Rate	$12.44
Max. Negotiated Rate	$258.12
Rate for Payer: Aetna Commercial	$196.18
Rate for Payer: Aetna Medicare Advantage	$154.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$103.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.64
Rate for Payer: Cigna Commercial	$258.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$113.58
Rate for Payer: Qualcare PPO/HMO/WC	$77.44
Rate for Payer: UnitedHealthcare Community & State	$12.44
Rate for Payer: Wellpoint Medicaid Managed Care	$13.68

STENT NEPHROSTOMY 8FR 24CM

Facility

$516.25

Service Code	HCPCS C2617
Hospital Charge Code	270665951N
Hospital Revenue Code	278
Min. Negotiated Rate	$77.44
Max. Negotiated Rate	$124.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$103.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$113.58
Rate for Payer: Qualcare PPO/HMO/WC	$77.44

STENT NEPHROSTOMY 8FR 24CM

Facility

$516.25

Service Code	HCPCS C2617
Hospital Charge Code	270665951N
Hospital Revenue Code	278
Min. Negotiated Rate	$12.44
Max. Negotiated Rate	$258.12
Rate for Payer: Aetna Commercial	$196.18
Rate for Payer: Aetna Medicare Advantage	$154.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$103.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.64
Rate for Payer: Cigna Commercial	$258.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$113.58
Rate for Payer: Qualcare PPO/HMO/WC	$77.44
Rate for Payer: UnitedHealthcare Community & State	$12.44
Rate for Payer: Wellpoint Medicaid Managed Care	$13.68

Know your out-of-pocket cost for care.

All Charges