Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENTP EVERFLX6FR BL 8X120X120

Facility

$1,695.00

Service Code	HCPCS C2617
Hospital Charge Code	270635523N
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

STENTP EVERFLX6FR BL 8X120X120

Facility

$8,350.00

Service Code	HCPCS C2617
Hospital Charge Code	270635523
Hospital Revenue Code	278
Min. Negotiated Rate	$201.24
Max. Negotiated Rate	$4,175.00
Rate for Payer: Aetna Commercial	$3,173.00
Rate for Payer: Aetna Medicare Advantage	$2,505.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,129.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,129.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,670.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,129.25
Rate for Payer: Cigna Commercial	$4,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,020.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,837.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,252.50
Rate for Payer: UnitedHealthcare Community & State	$201.24
Rate for Payer: Wellpoint Medicaid Managed Care	$221.28

STENTP EVERFLX6FR BL 8X120X120

Facility

$8,350.00

Service Code	HCPCS C2617
Hospital Charge Code	270635523
Hospital Revenue Code	278
Min. Negotiated Rate	$1,252.50
Max. Negotiated Rate	$2,020.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,670.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,020.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,837.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,252.50

STENTP EVERFLX6FR BL 8X60X120

Facility

$6,624.80

Service Code	HCPCS C1876
Hospital Charge Code	270635763
Hospital Revenue Code	278
Min. Negotiated Rate	$159.66
Max. Negotiated Rate	$3,312.40
Rate for Payer: Aetna Commercial	$2,517.42
Rate for Payer: Aetna Medicare Advantage	$1,987.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,689.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,689.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,324.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,689.32
Rate for Payer: Cigna Commercial	$3,312.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,603.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,457.46
Rate for Payer: Qualcare PPO/HMO/WC	$993.72
Rate for Payer: UnitedHealthcare Community & State	$159.66
Rate for Payer: Wellpoint Medicaid Managed Care	$175.56

STENTP EVERFLX6FR BL 8X60X120

Facility

$1,395.00

Service Code	HCPCS C1876
Hospital Charge Code	270635763N
Hospital Revenue Code	278
Min. Negotiated Rate	$33.62
Max. Negotiated Rate	$697.50
Rate for Payer: Aetna Commercial	$530.10
Rate for Payer: Aetna Medicare Advantage	$418.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$355.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$355.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$279.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$355.73
Rate for Payer: Cigna Commercial	$697.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$306.90
Rate for Payer: Qualcare PPO/HMO/WC	$209.25
Rate for Payer: UnitedHealthcare Community & State	$33.62
Rate for Payer: Wellpoint Medicaid Managed Care	$36.97

STENTP EVERFLX6FR BL 8X60X120

Facility

$6,624.80

Service Code	HCPCS C1876
Hospital Charge Code	270635763
Hospital Revenue Code	278
Min. Negotiated Rate	$993.72
Max. Negotiated Rate	$1,603.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,324.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,603.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,457.46
Rate for Payer: Qualcare PPO/HMO/WC	$993.72

STENTP EVERFLX6FR BL 8X60X120

Facility

$1,395.00

Service Code	HCPCS C1876
Hospital Charge Code	270635763S
Hospital Revenue Code	278
Min. Negotiated Rate	$209.25
Max. Negotiated Rate	$337.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$279.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$306.90
Rate for Payer: Qualcare PPO/HMO/WC	$209.25

STENTP EVERFLX6FR BL 8X60X120

Facility

$1,395.00

Service Code	HCPCS C1876
Hospital Charge Code	270635763N
Hospital Revenue Code	278
Min. Negotiated Rate	$209.25
Max. Negotiated Rate	$337.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$279.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$306.90
Rate for Payer: Qualcare PPO/HMO/WC	$209.25

STENTP EVERFLX6FR BL 8X60X120

Facility

$1,395.00

Service Code	HCPCS C1876
Hospital Charge Code	270635763S
Hospital Revenue Code	278
Min. Negotiated Rate	$33.62
Max. Negotiated Rate	$697.50
Rate for Payer: Aetna Commercial	$530.10
Rate for Payer: Aetna Medicare Advantage	$418.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$355.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$355.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$279.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$355.73
Rate for Payer: Cigna Commercial	$697.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$306.90
Rate for Payer: Qualcare PPO/HMO/WC	$209.25
Rate for Payer: UnitedHealthcare Community & State	$33.62
Rate for Payer: Wellpoint Medicaid Managed Care	$36.97

STENT P GPS 8x120SERB650812012

Facility

$9,176.00

Hospital Charge Code	270635523V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,376.40
Max. Negotiated Rate	$2,220.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,835.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,220.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,018.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,376.40

STENT P GPS 8x120SERB650812012

Facility

$9,176.00

Hospital Charge Code	270635523V
Hospital Revenue Code	278
Min. Negotiated Rate	$221.14
Max. Negotiated Rate	$4,588.00
Rate for Payer: Aetna Commercial	$3,486.88
Rate for Payer: Aetna Medicare Advantage	$2,752.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,339.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,339.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,835.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,339.88
Rate for Payer: Cigna Commercial	$4,588.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,220.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,018.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,376.40
Rate for Payer: UnitedHealthcare Community & State	$221.14
Rate for Payer: Wellpoint Medicaid Managed Care	$243.16

STENT P GPS SERB6506120120

Facility

$9,176.00

Hospital Charge Code	270635521V
Hospital Revenue Code	278
Min. Negotiated Rate	$221.14
Max. Negotiated Rate	$4,588.00
Rate for Payer: Aetna Commercial	$3,486.88
Rate for Payer: Aetna Medicare Advantage	$2,752.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,339.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,339.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,835.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,339.88
Rate for Payer: Cigna Commercial	$4,588.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,220.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,018.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,376.40
Rate for Payer: UnitedHealthcare Community & State	$221.14
Rate for Payer: Wellpoint Medicaid Managed Care	$243.16

STENT P GPS SERB6506120120

Facility

$9,176.00

Hospital Charge Code	270635521V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,376.40
Max. Negotiated Rate	$2,220.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,835.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,220.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,018.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,376.40

STENT P GPS SERB6506120120

Facility

$9,176.00

Hospital Charge Code	270635521
Hospital Revenue Code	278
Min. Negotiated Rate	$221.14
Max. Negotiated Rate	$4,588.00
Rate for Payer: Aetna Commercial	$3,486.88
Rate for Payer: Aetna Medicare Advantage	$2,752.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,339.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,339.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,835.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,339.88
Rate for Payer: Cigna Commercial	$4,588.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,220.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,018.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,376.40
Rate for Payer: UnitedHealthcare Community & State	$221.14
Rate for Payer: Wellpoint Medicaid Managed Care	$243.16

STENT P GPS SERB6506120120

Facility

$9,176.00

Hospital Charge Code	270635521
Hospital Revenue Code	278
Min. Negotiated Rate	$1,376.40
Max. Negotiated Rate	$2,220.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,835.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,220.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,018.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,376.40

STENT P GPS SERB65-07-120-120

Facility

$9,176.00

Hospital Charge Code	270635522
Hospital Revenue Code	278
Min. Negotiated Rate	$221.14
Max. Negotiated Rate	$4,588.00
Rate for Payer: Aetna Commercial	$3,486.88
Rate for Payer: Aetna Medicare Advantage	$2,752.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,339.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,339.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,835.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,339.88
Rate for Payer: Cigna Commercial	$4,588.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,220.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,018.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,376.40
Rate for Payer: UnitedHealthcare Community & State	$221.14
Rate for Payer: Wellpoint Medicaid Managed Care	$243.16

STENT P GPS SERB65-07-120-120

Facility

$9,176.00

Hospital Charge Code	270635522V
Hospital Revenue Code	278
Min. Negotiated Rate	$221.14
Max. Negotiated Rate	$4,588.00
Rate for Payer: Aetna Commercial	$3,486.88
Rate for Payer: Aetna Medicare Advantage	$2,752.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,339.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,339.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,835.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,339.88
Rate for Payer: Cigna Commercial	$4,588.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,220.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,018.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,376.40
Rate for Payer: UnitedHealthcare Community & State	$221.14
Rate for Payer: Wellpoint Medicaid Managed Care	$243.16

STENT P GPS SERB65-07-120-120

Facility

$9,176.00

Hospital Charge Code	270635522V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,376.40
Max. Negotiated Rate	$2,220.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,835.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,220.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,018.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,376.40

STENT P GPS SERB65-07-120-120

Facility

$9,176.00

Hospital Charge Code	270635522
Hospital Revenue Code	278
Min. Negotiated Rate	$1,376.40
Max. Negotiated Rate	$2,220.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,835.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,220.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,018.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,376.40

STENT PIGTAIL 10FR 7cm

Facility

$275.00

Service Code	HCPCS C2617
Hospital Charge Code	270658551
Hospital Revenue Code	278
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$104.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Community & State	$6.63
Rate for Payer: Wellpoint Medicaid Managed Care	$7.29

STENT PIGTAIL 10FR 7cm

Facility

$275.00

Service Code	HCPCS C2617
Hospital Charge Code	270658551
Hospital Revenue Code	278
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$66.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

STENT PIGTAIL 5 24CM *****

Facility

$414.00

Hospital Charge Code	1603927
Hospital Revenue Code	278
Min. Negotiated Rate	$9.98
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna Commercial	$157.32
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$91.08
Rate for Payer: Qualcare PPO/HMO/WC	$62.10
Rate for Payer: UnitedHealthcare Community & State	$9.98
Rate for Payer: Wellpoint Medicaid Managed Care	$10.97

STENT PIGTAIL 5 24CM *****

Facility

$414.00

Hospital Charge Code	1603927
Hospital Revenue Code	278
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$100.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$91.08
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

STENT PIGTAIL 5 24CM 031524***

Facility

$414.00

Hospital Charge Code	1604370
Hospital Revenue Code	278
Min. Negotiated Rate	$9.98
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna Commercial	$157.32
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$91.08
Rate for Payer: Qualcare PPO/HMO/WC	$62.10
Rate for Payer: UnitedHealthcare Community & State	$9.98
Rate for Payer: Wellpoint Medicaid Managed Care	$10.97

STENT PIGTAIL 5 24CM 031524***

Facility

$414.00

Hospital Charge Code	1604370
Hospital Revenue Code	278
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$100.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$91.08
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

Know your out-of-pocket cost for care.

All Charges