Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT PERIPH DIALYSIS SEGMENT

Facility

$48,741.55

Service Code	HCPCS 36903
Hospital Charge Code	5100837
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	7412058
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	$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

$48,741.55

Service Code	HCPCS 36903
Hospital Charge Code	5100837
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 PERIPHERAL 5.5X120MM 6FR

Facility

$9,945.00

Service Code	HCPCS C1876
Hospital Charge Code	270669064
Hospital Revenue Code	272
Min. Negotiated Rate	$239.67
Max. Negotiated Rate	$4,972.50
Rate for Payer: Aetna Commercial	$3,779.10
Rate for Payer: Aetna Medicare Advantage	$2,983.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,535.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,535.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,535.97
Rate for Payer: Cigna Commercial	$4,972.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,983.50
Rate for Payer: Oxford Commercial	$1,989.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,491.75
Rate for Payer: UnitedHealthcare Commercial	$1,989.00
Rate for Payer: UnitedHealthcare Community & State	$239.67
Rate for Payer: Wellpoint Medicaid Managed Care	$263.54

STENT PERIPHERAL 5.5X120MM 6FR

Facility

$9,945.00

Service Code	HCPCS C1876
Hospital Charge Code	270669064
Hospital Revenue Code	272
Min. Negotiated Rate	$1,491.75
Max. Negotiated Rate	$1,491.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,491.75

STENT PERIPHERAL 5.5X40MM 6FR

Facility

$7,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270669063
Hospital Revenue Code	278
Min. Negotiated Rate	$186.78
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,945.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50
Rate for Payer: UnitedHealthcare Community & State	$186.78
Rate for Payer: Wellpoint Medicaid Managed Care	$205.38

STENT PERIPHERAL 5.5X40MM 6FR

Facility

$7,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270669063
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

STENT PERIPHERAL 5.5x80MM 6FR

Facility

$7,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270668890S
Hospital Revenue Code	278
Min. Negotiated Rate	$186.78
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,945.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50
Rate for Payer: UnitedHealthcare Community & State	$186.78
Rate for Payer: Wellpoint Medicaid Managed Care	$205.38

STENT PERIPHERAL 5.5x80MM 6FR

Facility

$8,805.00

Service Code	HCPCS C1876
Hospital Charge Code	270668890
Hospital Revenue Code	272
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) PPO	$2,245.28
Rate for Payer: Cigna Commercial	$4,402.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,641.50
Rate for Payer: Oxford Commercial	$1,761.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,320.75
Rate for Payer: UnitedHealthcare Commercial	$1,761.00
Rate for Payer: UnitedHealthcare Community & State	$212.20
Rate for Payer: Wellpoint Medicaid Managed Care	$233.33

STENT PERIPHERAL 5.5x80MM 6FR

Facility

$8,805.00

Service Code	HCPCS C1876
Hospital Charge Code	270668890
Hospital Revenue Code	272
Min. Negotiated Rate	$1,320.75
Max. Negotiated Rate	$1,320.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,320.75

STENT PERIPHERAL 5.5x80MM 6FR

Facility

$7,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270668890S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

STENT PERIPHERAL 5.5x80MM 6FR

Facility

$7,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270668890N
Hospital Revenue Code	278
Min. Negotiated Rate	$186.78
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,945.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50
Rate for Payer: UnitedHealthcare Community & State	$186.78
Rate for Payer: Wellpoint Medicaid Managed Care	$205.38

STENT PERIPHERAL 5.5x80MM 6FR

Facility

$7,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270668890N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

STENT PERIPHERAL 5x100x120 6F

Facility

$8,805.00

Hospital Charge Code	270705281
Hospital Revenue Code	272
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) PPO	$2,245.28
Rate for Payer: Cigna Commercial	$4,402.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,641.50
Rate for Payer: Oxford Commercial	$1,761.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,320.75
Rate for Payer: UnitedHealthcare Commercial	$1,761.00
Rate for Payer: UnitedHealthcare Community & State	$212.20
Rate for Payer: Wellpoint Medicaid Managed Care	$233.33

STENT PERIPHERAL 5x100x120 6F

Facility

$8,805.00

Hospital Charge Code	270705281
Hospital Revenue Code	272
Min. Negotiated Rate	$1,320.75
Max. Negotiated Rate	$1,320.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,320.75

STENT PERMALUME 10X40 6970

Facility

$7,775.00

Hospital Charge Code	270638527
Hospital Revenue Code	278
Min. Negotiated Rate	$187.38
Max. Negotiated Rate	$3,887.50
Rate for Payer: Aetna Commercial	$2,954.50
Rate for Payer: Aetna Medicare Advantage	$2,332.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,982.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,982.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,555.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,982.62
Rate for Payer: Cigna Commercial	$3,887.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,881.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,710.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,166.25
Rate for Payer: UnitedHealthcare Community & State	$187.38
Rate for Payer: Wellpoint Medicaid Managed Care	$206.04

STENT PERMALUME 10X40 6970

Facility

$7,775.00

Hospital Charge Code	270638527
Hospital Revenue Code	278
Min. Negotiated Rate	$1,166.25
Max. Negotiated Rate	$1,881.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,555.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,881.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,710.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,166.25

STENTP EVERFLX6FR BL 7X30X120

Facility

$6,975.00

Service Code	HCPCS C2617
Hospital Charge Code	270644086S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,046.25
Max. Negotiated Rate	$1,687.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,687.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,534.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25

STENTP EVERFLX6FR BL 7X30X120

Facility

$6,975.00

Service Code	HCPCS C2617
Hospital Charge Code	270644086S
Hospital Revenue Code	278
Min. Negotiated Rate	$168.10
Max. Negotiated Rate	$3,487.50
Rate for Payer: Aetna Commercial	$2,650.50
Rate for Payer: Aetna Medicare Advantage	$2,092.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,778.62
Rate for Payer: Cigna Commercial	$3,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,687.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,534.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25
Rate for Payer: UnitedHealthcare Community & State	$168.10
Rate for Payer: Wellpoint Medicaid Managed Care	$184.84

STENTP EVERFLX6FR BL 7X30X120

Facility

$4,500.00

Service Code	HCPCS C2617
Hospital Charge Code	270644086
Hospital Revenue Code	278
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

STENTP EVERFLX6FR BL 7X30X120

Facility

$4,500.00

Service Code	HCPCS C2617
Hospital Charge Code	270644086
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENTP EVERFLX6FR BL 8X120X120

Facility

$1,695.00

Service Code	HCPCS C2617
Hospital Charge Code	270635523N
Hospital Revenue Code	278
Min. Negotiated Rate	$40.85
Max. Negotiated Rate	$847.50
Rate for Payer: Aetna Commercial	$644.10
Rate for Payer: Aetna Medicare Advantage	$508.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$432.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$432.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$339.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$432.23
Rate for Payer: Cigna Commercial	$847.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$410.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$372.90
Rate for Payer: Qualcare PPO/HMO/WC	$254.25
Rate for Payer: UnitedHealthcare Community & State	$40.85
Rate for Payer: Wellpoint Medicaid Managed Care	$44.92

STENTP EVERFLX6FR BL 8X120X120

Facility

$1,695.00

Service Code	HCPCS C2617
Hospital Charge Code	270635523S
Hospital Revenue Code	278
Min. Negotiated Rate	$40.85
Max. Negotiated Rate	$847.50
Rate for Payer: Aetna Commercial	$644.10
Rate for Payer: Aetna Medicare Advantage	$508.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$432.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$432.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$339.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$432.23
Rate for Payer: Cigna Commercial	$847.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$410.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$372.90
Rate for Payer: Qualcare PPO/HMO/WC	$254.25
Rate for Payer: UnitedHealthcare Community & State	$40.85
Rate for Payer: Wellpoint Medicaid Managed Care	$44.92

STENTP EVERFLX6FR BL 8X120X120

Facility

$1,695.00

Service Code	HCPCS C2617
Hospital Charge Code	270635523S
Hospital Revenue Code	278
Min. Negotiated Rate	$254.25
Max. Negotiated Rate	$410.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$339.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$410.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$372.90
Rate for Payer: Qualcare PPO/HMO/WC	$254.25

Know your out-of-pocket cost for care.

All Charges