Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT PIGTAIL 5 25CM ******

Facility

$414.00

Hospital Charge Code	1605138
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 25CM ******

Facility

$414.00

Hospital Charge Code	1605138
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 27CM 031527***

Facility

$414.00

Hospital Charge Code	1604339
Hospital Revenue Code	272
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$62.10
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

STENT PIGTAIL 5 27CM 031527***

Facility

$414.00

Hospital Charge Code	1604339
Hospital Revenue Code	272
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) PPO	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.20
Rate for Payer: Oxford Commercial	$82.80
Rate for Payer: Qualcare PPO/HMO/WC	$62.10
Rate for Payer: UnitedHealthcare Commercial	$82.80
Rate for Payer: UnitedHealthcare Community & State	$9.98
Rate for Payer: Wellpoint Medicaid Managed Care	$10.97

STENT PIGTAIL 7 27CM 031727***

Facility

$414.00

Hospital Charge Code	1604347
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 7 27CM 031727***

Facility

$414.00

Hospital Charge Code	1604347
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 7FR/10CM

Facility

$295.00

Hospital Charge Code	270655036
Hospital Revenue Code	278
Min. Negotiated Rate	$44.25
Max. Negotiated Rate	$71.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$64.90
Rate for Payer: Qualcare PPO/HMO/WC	$44.25

STENT PIGTAIL 7FR/10CM

Facility

$295.00

Hospital Charge Code	270655036
Hospital Revenue Code	278
Min. Negotiated Rate	$7.11
Max. Negotiated Rate	$147.50
Rate for Payer: Aetna Commercial	$112.10
Rate for Payer: Aetna Medicare Advantage	$88.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.22
Rate for Payer: Cigna Commercial	$147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$64.90
Rate for Payer: Qualcare PPO/HMO/WC	$44.25
Rate for Payer: UnitedHealthcare Community & State	$7.11
Rate for Payer: Wellpoint Medicaid Managed Care	$7.82

STENT PIGTAIL DBL 7F 25CM****

Facility

$414.00

Hospital Charge Code	1604354
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 DBL 7F 25CM****

Facility

$414.00

Hospital Charge Code	1604354
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 PIGTL DRAIN 10 5CM 3204

Facility

$502.45

Hospital Charge Code	270600941
Hospital Revenue Code	278
Min. Negotiated Rate	$12.11
Max. Negotiated Rate	$251.22
Rate for Payer: Aetna Commercial	$190.93
Rate for Payer: Aetna Medicare Advantage	$150.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.12
Rate for Payer: Cigna Commercial	$251.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.54
Rate for Payer: Qualcare PPO/HMO/WC	$75.37
Rate for Payer: UnitedHealthcare Community & State	$12.11
Rate for Payer: Wellpoint Medicaid Managed Care	$13.31

STENT PIGTL DRAIN 10 5CM 3204

Facility

$502.45

Hospital Charge Code	270600941
Hospital Revenue Code	278
Min. Negotiated Rate	$75.37
Max. Negotiated Rate	$121.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.54
Rate for Payer: Qualcare PPO/HMO/WC	$75.37

STENT PIGTL DRAIN 7FR 5CM 3201

Facility

$502.45

Hospital Charge Code	270600937
Hospital Revenue Code	278
Min. Negotiated Rate	$12.11
Max. Negotiated Rate	$251.22
Rate for Payer: Aetna Commercial	$190.93
Rate for Payer: Aetna Medicare Advantage	$150.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.12
Rate for Payer: Cigna Commercial	$251.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.54
Rate for Payer: Qualcare PPO/HMO/WC	$75.37
Rate for Payer: UnitedHealthcare Community & State	$12.11
Rate for Payer: Wellpoint Medicaid Managed Care	$13.31

STENT PIGTL DRAIN 7FR 5CM 3201

Facility

$502.45

Hospital Charge Code	270600937
Hospital Revenue Code	278
Min. Negotiated Rate	$75.37
Max. Negotiated Rate	$121.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.54
Rate for Payer: Qualcare PPO/HMO/WC	$75.37

STENT PIPELINESHIELD 4.25X12MM

Facility

$89,300.00

Service Code	HCPCS C1889
Hospital Charge Code	270699009S
Hospital Revenue Code	278
Min. Negotiated Rate	$13,395.00
Max. Negotiated Rate	$21,610.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,610.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19,646.00
Rate for Payer: Qualcare PPO/HMO/WC	$13,395.00

STENT PIPELINESHIELD 4.25X12MM

Facility

$89,300.00

Service Code	HCPCS C1889
Hospital Charge Code	270699009S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,152.13
Max. Negotiated Rate	$44,650.00
Rate for Payer: Aetna Commercial	$33,934.00
Rate for Payer: Aetna Medicare Advantage	$26,790.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,771.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,771.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,860.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22,771.50
Rate for Payer: Cigna Commercial	$44,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,610.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19,646.00
Rate for Payer: Qualcare PPO/HMO/WC	$13,395.00
Rate for Payer: UnitedHealthcare Community & State	$2,152.13
Rate for Payer: Wellpoint Medicaid Managed Care	$2,366.45

STENT PIPELINE SHIELD 4.5X12MM

Facility

$89,300.00

Service Code	HCPCS C1889
Hospital Charge Code	270699274S
Hospital Revenue Code	278
Min. Negotiated Rate	$13,395.00
Max. Negotiated Rate	$21,610.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,610.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19,646.00
Rate for Payer: Qualcare PPO/HMO/WC	$13,395.00

STENT PIPELINE SHIELD 4.5X12MM

Facility

$89,300.00

Service Code	HCPCS C1889
Hospital Charge Code	270699274S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,152.13
Max. Negotiated Rate	$44,650.00
Rate for Payer: Aetna Commercial	$33,934.00
Rate for Payer: Aetna Medicare Advantage	$26,790.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,771.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,771.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,860.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22,771.50
Rate for Payer: Cigna Commercial	$44,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,610.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19,646.00
Rate for Payer: Qualcare PPO/HMO/WC	$13,395.00
Rate for Payer: UnitedHealthcare Community & State	$2,152.13
Rate for Payer: Wellpoint Medicaid Managed Care	$2,366.45

STENT PIPELINE SHIELD 4.5X14MM

Facility

$89,300.00

Service Code	HCPCS C1889
Hospital Charge Code	270699630S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,152.13
Max. Negotiated Rate	$44,650.00
Rate for Payer: Aetna Commercial	$33,934.00
Rate for Payer: Aetna Medicare Advantage	$26,790.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,771.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,771.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,860.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22,771.50
Rate for Payer: Cigna Commercial	$44,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,610.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19,646.00
Rate for Payer: Qualcare PPO/HMO/WC	$13,395.00
Rate for Payer: UnitedHealthcare Community & State	$2,152.13
Rate for Payer: Wellpoint Medicaid Managed Care	$2,366.45

STENT PIPELINE SHIELD 4.5X14MM

Facility

$89,300.00

Service Code	HCPCS C1889
Hospital Charge Code	270699630S
Hospital Revenue Code	278
Min. Negotiated Rate	$13,395.00
Max. Negotiated Rate	$21,610.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,610.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19,646.00
Rate for Payer: Qualcare PPO/HMO/WC	$13,395.00

STENT PIPELINE SHIELD 4X10MM

Facility

$89,300.00

Service Code	HCPCS C1889
Hospital Charge Code	270699005S
Hospital Revenue Code	278
Min. Negotiated Rate	$13,395.00
Max. Negotiated Rate	$21,610.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,610.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19,646.00
Rate for Payer: Qualcare PPO/HMO/WC	$13,395.00

STENT PIPELINE SHIELD 4X10MM

Facility

$89,300.00

Service Code	HCPCS C1889
Hospital Charge Code	270699005S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,152.13
Max. Negotiated Rate	$44,650.00
Rate for Payer: Aetna Commercial	$33,934.00
Rate for Payer: Aetna Medicare Advantage	$26,790.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,771.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,771.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,860.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22,771.50
Rate for Payer: Cigna Commercial	$44,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,610.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19,646.00
Rate for Payer: Qualcare PPO/HMO/WC	$13,395.00
Rate for Payer: UnitedHealthcare Community & State	$2,152.13
Rate for Payer: Wellpoint Medicaid Managed Care	$2,366.45

STENT PIPELINE SHIELD 4x14MM

Facility

$89,300.00

Service Code	HCPCS C1889
Hospital Charge Code	270699008S
Hospital Revenue Code	278
Min. Negotiated Rate	$13,395.00
Max. Negotiated Rate	$21,610.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,610.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19,646.00
Rate for Payer: Qualcare PPO/HMO/WC	$13,395.00

STENT PIPELINE SHIELD 4x14MM

Facility

$89,300.00

Service Code	HCPCS C1889
Hospital Charge Code	270699008S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,152.13
Max. Negotiated Rate	$44,650.00
Rate for Payer: Aetna Commercial	$33,934.00
Rate for Payer: Aetna Medicare Advantage	$26,790.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,771.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,771.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,860.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22,771.50
Rate for Payer: Cigna Commercial	$44,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,610.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19,646.00
Rate for Payer: Qualcare PPO/HMO/WC	$13,395.00
Rate for Payer: UnitedHealthcare Community & State	$2,152.13
Rate for Payer: Wellpoint Medicaid Managed Care	$2,366.45

STENT PLACEMT ANTE CAROTID

Facility

$4,328.00

Service Code	HCPCS 37218
Hospital Charge Code	366837218
Hospital Revenue Code	361
Min. Negotiated Rate	$649.20
Max. Negotiated Rate	$649.20
Rate for Payer: Qualcare PPO/HMO/WC	$649.20

Know your out-of-pocket cost for care.

All Charges