Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT PERCUFLEX 10x12

Facility

$475.00

Hospital Charge Code	270650918
Hospital Revenue Code	278
Min. Negotiated Rate	$11.45
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Community & State	$11.45
Rate for Payer: Wellpoint Medicaid Managed Care	$12.59

STENT PERCUFLEX 7FR 24 175-272

Facility

$694.45

Hospital Charge Code	270623138
Hospital Revenue Code	278
Min. Negotiated Rate	$104.17
Max. Negotiated Rate	$168.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$138.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$152.78
Rate for Payer: Qualcare PPO/HMO/WC	$104.17

STENT PERCUFLEX 7FR 24 175-272

Facility

$694.45

Hospital Charge Code	270623138
Hospital Revenue Code	278
Min. Negotiated Rate	$16.74
Max. Negotiated Rate	$347.23
Rate for Payer: Aetna Commercial	$263.89
Rate for Payer: Aetna Medicare Advantage	$208.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$138.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.08
Rate for Payer: Cigna Commercial	$347.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$152.78
Rate for Payer: Qualcare PPO/HMO/WC	$104.17
Rate for Payer: UnitedHealthcare Community & State	$16.74
Rate for Payer: Wellpoint Medicaid Managed Care	$18.40

STENT PERCUFLEX 7x10

Facility

$535.00

Hospital Charge Code	270650915
Hospital Revenue Code	278
Min. Negotiated Rate	$80.25
Max. Negotiated Rate	$129.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$107.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$117.70
Rate for Payer: Qualcare PPO/HMO/WC	$80.25

STENT PERCUFLEX 7x10

Facility

$535.00

Hospital Charge Code	270650915
Hospital Revenue Code	278
Min. Negotiated Rate	$12.89
Max. Negotiated Rate	$267.50
Rate for Payer: Aetna Commercial	$203.30
Rate for Payer: Aetna Medicare Advantage	$160.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$107.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.43
Rate for Payer: Cigna Commercial	$267.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$117.70
Rate for Payer: Qualcare PPO/HMO/WC	$80.25
Rate for Payer: UnitedHealthcare Community & State	$12.89
Rate for Payer: Wellpoint Medicaid Managed Care	$14.18

STENT PERCUFLEX 7x5

Facility

$495.00

Hospital Charge Code	270650913
Hospital Revenue Code	278
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$119.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

STENT PERCUFLEX 7x5

Facility

$495.00

Hospital Charge Code	270650913
Hospital Revenue Code	278
Min. Negotiated Rate	$11.93
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$188.10
Rate for Payer: Aetna Medicare Advantage	$148.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.22
Rate for Payer: Cigna Commercial	$247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$74.25
Rate for Payer: UnitedHealthcare Community & State	$11.93
Rate for Payer: Wellpoint Medicaid Managed Care	$13.12

STENT PERCUFLEX 8FR 22cm

Facility

$618.00

Service Code	HCPCS C2617
Hospital Charge Code	270623953
Hospital Revenue Code	278
Min. Negotiated Rate	$92.70
Max. Negotiated Rate	$149.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$135.96
Rate for Payer: Qualcare PPO/HMO/WC	$92.70

STENT PERCUFLEX 8FR 22cm

Facility

$618.00

Service Code	HCPCS C2617
Hospital Charge Code	270623953
Hospital Revenue Code	278
Min. Negotiated Rate	$14.89
Max. Negotiated Rate	$309.00
Rate for Payer: Aetna Commercial	$234.84
Rate for Payer: Aetna Medicare Advantage	$185.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$157.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$157.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$157.59
Rate for Payer: Cigna Commercial	$309.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$135.96
Rate for Payer: Qualcare PPO/HMO/WC	$92.70
Rate for Payer: UnitedHealthcare Community & State	$14.89
Rate for Payer: Wellpoint Medicaid Managed Care	$16.38

STENT PERCUFLEX PLUS URTERAL

Facility

$406.25

Service Code	HCPCS C2617
Hospital Charge Code	270658587
Hospital Revenue Code	278
Min. Negotiated Rate	$9.79
Max. Negotiated Rate	$203.12
Rate for Payer: Aetna Commercial	$154.38
Rate for Payer: Aetna Medicare Advantage	$121.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.59
Rate for Payer: Cigna Commercial	$203.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$89.38
Rate for Payer: Qualcare PPO/HMO/WC	$60.94
Rate for Payer: UnitedHealthcare Community & State	$9.79
Rate for Payer: Wellpoint Medicaid Managed Care	$10.77

STENT PERCUFLEX PLUS URTERAL

Facility

$406.25

Service Code	HCPCS C2617
Hospital Charge Code	270658587
Hospital Revenue Code	278
Min. Negotiated Rate	$60.94
Max. Negotiated Rate	$98.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$89.38
Rate for Payer: Qualcare PPO/HMO/WC	$60.94

STENT PERCULFLEX 7x12

Facility

$475.00

Hospital Charge Code	270650917
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

STENT PERCULFLEX 7x12

Facility

$475.00

Hospital Charge Code	270650917
Hospital Revenue Code	278
Min. Negotiated Rate	$11.45
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Community & State	$11.45
Rate for Payer: Wellpoint Medicaid Managed Care	$12.59

STENT PERFCUFLEX 7x7

Facility

$475.00

Hospital Charge Code	270650914
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

STENT PERFCUFLEX 7x7

Facility

$475.00

Hospital Charge Code	270650914
Hospital Revenue Code	278
Min. Negotiated Rate	$11.45
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Community & State	$11.45
Rate for Payer: Wellpoint Medicaid Managed Care	$12.59

STENT PERIP 4 5X80 S45080120P6

Facility

$8,805.00

Service Code	HCPCS C1876
Hospital Charge Code	270668911
Hospital Revenue Code	278
Min. Negotiated Rate	$1,320.75
Max. Negotiated Rate	$2,130.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,761.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,130.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,937.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,320.75

STENT PERIP 4 5X80 S45080120P6

Facility

$8,805.00

Service Code	HCPCS C1876
Hospital Charge Code	270668911
Hospital Revenue Code	278
Min. Negotiated Rate	$212.20
Max. Negotiated Rate	$4,402.50
Rate for Payer: Aetna Commercial	$3,345.90
Rate for Payer: Aetna Medicare Advantage	$2,641.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,245.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,245.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,761.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,245.28
Rate for Payer: Cigna Commercial	$4,402.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,130.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,937.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,320.75
Rate for Payer: UnitedHealthcare Community & State	$212.20
Rate for Payer: Wellpoint Medicaid Managed Care	$233.33

STENT PERIPH DIALYSIS SEGMENT

Facility

$48,741.55

Service Code	HCPCS 36903
Hospital Charge Code	366836903
Hospital Revenue Code	361
Min. Negotiated Rate	$1,174.67
Max. Negotiated Rate	$49,506.31
Rate for Payer: Aetna Commercial	$37,304.26
Rate for Payer: Aetna Medicare Advantage	$44,435.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,506.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,506.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,714.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,506.31
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: Cigna Medicare Advantage	$13,714.80
Rate for Payer: Clover Medicare Advantage	$13,029.06
Rate for Payer: EmblemHealth Commercial	$41,144.40
Rate for Payer: Humana Medicare Advantage	$14,126.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,714.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,622.47
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,311.23
Rate for Payer: UnitedHealthcare Commercial	$16,605.00
Rate for Payer: UnitedHealthcare Community & State	$1,174.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare Medicare Advantage	$13,714.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1,291.65

STENT PERIPH DIALYSIS SEGMENT

Facility

$48,741.55

Service Code	HCPCS 36903
Hospital Charge Code	2709024
Hospital Revenue Code	361
Min. Negotiated Rate	$7,311.23
Max. Negotiated Rate	$7,311.23
Rate for Payer: Qualcare PPO/HMO/WC	$7,311.23

STENT PERIPH DIALYSIS SEGMENT

Facility

$48,741.55

Service Code	HCPCS 36903
Hospital Charge Code	366836903
Hospital Revenue Code	361
Min. Negotiated Rate	$7,311.23
Max. Negotiated Rate	$7,311.23
Rate for Payer: Qualcare PPO/HMO/WC	$7,311.23

STENT PERIPH DIALYSIS SEGMENT

Facility

$56,620.95

Service Code	HCPCS 36903
Hospital Charge Code	321036903
Hospital Revenue Code	361
Min. Negotiated Rate	$1,364.56
Max. Negotiated Rate	$49,506.31
Rate for Payer: Aetna Commercial	$37,304.26
Rate for Payer: Aetna Medicare Advantage	$44,435.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,506.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,506.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,714.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,506.31
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: Cigna Medicare Advantage	$13,714.80
Rate for Payer: Clover Medicare Advantage	$13,029.06
Rate for Payer: EmblemHealth Commercial	$41,144.40
Rate for Payer: Humana Medicare Advantage	$14,126.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,714.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,986.28
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,493.14
Rate for Payer: UnitedHealthcare Commercial	$16,605.00
Rate for Payer: UnitedHealthcare Community & State	$1,364.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare Medicare Advantage	$13,714.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1,500.46

STENT PERIPH DIALYSIS SEGMENT

Facility

$56,620.95

Service Code	HCPCS 36903
Hospital Charge Code	321036903
Hospital Revenue Code	361
Min. Negotiated Rate	$8,493.14
Max. Negotiated Rate	$8,493.14
Rate for Payer: Qualcare PPO/HMO/WC	$8,493.14

STENT PERIPH DIALYSIS SEGMENT

Facility

$48,741.55

Service Code	HCPCS 36903
Hospital Charge Code	7412058
Hospital Revenue Code	361
Min. Negotiated Rate	$7,311.23
Max. Negotiated Rate	$7,311.23
Rate for Payer: Qualcare PPO/HMO/WC	$7,311.23

STENT PERIPH DIALYSIS SEGMENT

Facility

$48,741.55

Service Code	HCPCS 36903
Hospital Charge Code	2709024
Hospital Revenue Code	361
Min. Negotiated Rate	$1,174.67
Max. Negotiated Rate	$49,506.31
Rate for Payer: Aetna Commercial	$37,304.26
Rate for Payer: Aetna Medicare Advantage	$44,435.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,506.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,506.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,714.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,506.31
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: Cigna Medicare Advantage	$13,714.80
Rate for Payer: Clover Medicare Advantage	$13,029.06
Rate for Payer: EmblemHealth Commercial	$41,144.40
Rate for Payer: Humana Medicare Advantage	$14,126.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,714.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,622.47
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,311.23
Rate for Payer: UnitedHealthcare Commercial	$16,605.00
Rate for Payer: UnitedHealthcare Community & State	$1,174.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare Medicare Advantage	$13,714.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1,291.65

STENT PERIPH DIALYSIS SEGMENT

Facility

$56,620.95

Service Code	HCPCS 36903
Hospital Charge Code	2692129
Hospital Revenue Code	361
Min. Negotiated Rate	$8,493.14
Max. Negotiated Rate	$8,493.14
Rate for Payer: Qualcare PPO/HMO/WC	$8,493.14

Know your out-of-pocket cost for care.

All Charges