Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT PRECISE RX 6 MM x 40 MM

Facility

$8,825.00

Service Code	HCPCS C1876
Hospital Charge Code	270683811N
Hospital Revenue Code	272
Min. Negotiated Rate	$212.68
Max. Negotiated Rate	$4,412.50
Rate for Payer: Aetna Commercial	$3,353.50
Rate for Payer: Aetna Medicare Advantage	$2,647.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,250.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,250.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,250.38
Rate for Payer: Cigna Commercial	$4,412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,647.50
Rate for Payer: Oxford Commercial	$1,765.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,323.75
Rate for Payer: UnitedHealthcare Commercial	$1,765.00
Rate for Payer: UnitedHealthcare Community & State	$212.68
Rate for Payer: Wellpoint Medicaid Managed Care	$233.86

STENT PRECISE RX 6 MM x 40 MM

Facility

$8,825.00

Service Code	HCPCS C1876
Hospital Charge Code	270683811N
Hospital Revenue Code	272
Min. Negotiated Rate	$1,323.75
Max. Negotiated Rate	$1,323.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,323.75

STENT PRECISE RX 6 MM x 40 MM

Facility

$8,825.00

Service Code	HCPCS C1876
Hospital Charge Code	270683811
Hospital Revenue Code	272
Min. Negotiated Rate	$1,323.75
Max. Negotiated Rate	$1,323.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,323.75

STENT PRECISE RX 6 MM x 40 MM

Facility

$8,825.00

Service Code	HCPCS C1876
Hospital Charge Code	270683811
Hospital Revenue Code	272
Min. Negotiated Rate	$212.68
Max. Negotiated Rate	$4,412.50
Rate for Payer: Aetna Commercial	$3,353.50
Rate for Payer: Aetna Medicare Advantage	$2,647.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,250.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,250.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,250.38
Rate for Payer: Cigna Commercial	$4,412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,647.50
Rate for Payer: Oxford Commercial	$1,765.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,323.75
Rate for Payer: UnitedHealthcare Commercial	$1,765.00
Rate for Payer: UnitedHealthcare Community & State	$212.68
Rate for Payer: Wellpoint Medicaid Managed Care	$233.86

STENT PRECSE BILI 7x40m N740SB

Facility

$9,750.00

Hospital Charge Code	270628403V
Hospital Revenue Code	278
Min. Negotiated Rate	$234.97
Max. Negotiated Rate	$4,875.00
Rate for Payer: Aetna Commercial	$3,705.00
Rate for Payer: Aetna Medicare Advantage	$2,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,486.25
Rate for Payer: Cigna Commercial	$4,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,145.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50
Rate for Payer: UnitedHealthcare Community & State	$234.97
Rate for Payer: Wellpoint Medicaid Managed Care	$258.38

STENT PRECSE BILI 7x40m N740SB

Facility

$9,750.00

Hospital Charge Code	270628403V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,462.50
Max. Negotiated Rate	$2,359.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,145.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50

STENT PRECSE BILI 7x40m N740SB

Facility

$9,672.00

Hospital Charge Code	270628403
Hospital Revenue Code	278
Min. Negotiated Rate	$233.10
Max. Negotiated Rate	$4,836.00
Rate for Payer: Aetna Commercial	$3,675.36
Rate for Payer: Aetna Medicare Advantage	$2,901.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,466.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,466.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,934.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,466.36
Rate for Payer: Cigna Commercial	$4,836.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,340.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,127.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,450.80
Rate for Payer: UnitedHealthcare Community & State	$233.10
Rate for Payer: Wellpoint Medicaid Managed Care	$256.31

STENT PRECSE BILI 7x40m N740SB

Facility

$9,672.00

Hospital Charge Code	270628403
Hospital Revenue Code	278
Min. Negotiated Rate	$1,450.80
Max. Negotiated Rate	$2,340.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,934.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,340.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,127.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,450.80

STENT PRECSE RX 6x30 P06030RXB

Facility

$10,639.25

Service Code	HCPCS C1876
Hospital Charge Code	270631755
Hospital Revenue Code	278
Min. Negotiated Rate	$1,595.89
Max. Negotiated Rate	$2,574.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,127.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,574.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,340.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,595.89

STENT PRECSE RX 6x30 P06030RXB

Facility

$10,639.25

Service Code	HCPCS C1876
Hospital Charge Code	270631755
Hospital Revenue Code	278
Min. Negotiated Rate	$256.41
Max. Negotiated Rate	$5,319.62
Rate for Payer: Aetna Commercial	$4,042.91
Rate for Payer: Aetna Medicare Advantage	$3,191.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,713.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,713.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,127.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,713.01
Rate for Payer: Cigna Commercial	$5,319.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,574.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,340.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,595.89
Rate for Payer: UnitedHealthcare Community & State	$256.41
Rate for Payer: Wellpoint Medicaid Managed Care	$281.94

STENT PRECSE RX 6x40 P06040RXB

Facility

$10,639.25

Hospital Charge Code	270631756
Hospital Revenue Code	278
Min. Negotiated Rate	$1,595.89
Max. Negotiated Rate	$2,574.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,127.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,574.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,340.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,595.89

STENT PRECSE RX 6x40 P06040RXB

Facility

$10,639.25

Hospital Charge Code	270631756
Hospital Revenue Code	278
Min. Negotiated Rate	$256.41
Max. Negotiated Rate	$5,319.62
Rate for Payer: Aetna Commercial	$4,042.91
Rate for Payer: Aetna Medicare Advantage	$3,191.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,713.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,713.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,127.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,713.01
Rate for Payer: Cigna Commercial	$5,319.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,574.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,340.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,595.89
Rate for Payer: UnitedHealthcare Community & State	$256.41
Rate for Payer: Wellpoint Medicaid Managed Care	$281.94

STENT PRECSE RX 7x30 P07030RX3

Facility

$10,639.25

Hospital Charge Code	270631757
Hospital Revenue Code	278
Min. Negotiated Rate	$1,595.89
Max. Negotiated Rate	$2,574.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,127.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,574.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,340.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,595.89

STENT PRECSE RX 7x30 P07030RX3

Facility

$10,639.25

Hospital Charge Code	270631757
Hospital Revenue Code	278
Min. Negotiated Rate	$256.41
Max. Negotiated Rate	$5,319.62
Rate for Payer: Aetna Commercial	$4,042.91
Rate for Payer: Aetna Medicare Advantage	$3,191.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,713.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,713.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,127.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,713.01
Rate for Payer: Cigna Commercial	$5,319.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,574.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,340.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,595.89
Rate for Payer: UnitedHealthcare Community & State	$256.41
Rate for Payer: Wellpoint Medicaid Managed Care	$281.94

STENT PRECSE RX 7x30 P07030RX3

Facility

$10,725.00

Hospital Charge Code	270631757V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,608.75
Max. Negotiated Rate	$2,595.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,595.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,608.75

STENT PRECSE RX 7x30 P07030RX3

Facility

$10,725.00

Hospital Charge Code	270631757V
Hospital Revenue Code	278
Min. Negotiated Rate	$258.47
Max. Negotiated Rate	$5,362.50
Rate for Payer: Aetna Commercial	$4,075.50
Rate for Payer: Aetna Medicare Advantage	$3,217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,734.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,734.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,734.88
Rate for Payer: Cigna Commercial	$5,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,595.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,608.75
Rate for Payer: UnitedHealthcare Community & State	$258.47
Rate for Payer: Wellpoint Medicaid Managed Care	$284.21

STENT PRGE 6x150 PRB3606150120

Facility

$7,500.00

Hospital Charge Code	270637891V
Hospital Revenue Code	278
Min. Negotiated Rate	$180.75
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$180.75
Rate for Payer: Wellpoint Medicaid Managed Care	$198.75

STENT PRGE 6x150 PRB3606150120

Facility

$7,500.00

Hospital Charge Code	270637891V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

STENT PRMS RX 2.5X1 100953912B

Facility

$10,250.00

Hospital Charge Code	270642158C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$2,480.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,255.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

STENT PRMS RX 2.5X1 100953912B

Facility

$10,250.00

Hospital Charge Code	270642158C
Hospital Revenue Code	278
Min. Negotiated Rate	$247.03
Max. Negotiated Rate	$5,125.00
Rate for Payer: Aetna Commercial	$3,895.00
Rate for Payer: Aetna Medicare Advantage	$3,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,613.75
Rate for Payer: Cigna Commercial	$5,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,255.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50
Rate for Payer: UnitedHealthcare Community & State	$247.03
Rate for Payer: Wellpoint Medicaid Managed Care	$271.62

STENT PRO 10x7x30 SECX10730135

Facility

$10,500.00

Hospital Charge Code	270643392V
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

STENT PRO 10x7x30 SECX10730135

Facility

$10,500.00

Hospital Charge Code	270643392V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

STENT PRO 8X80 PRB35-08-80-120

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270637010C
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

STENT PRO 8X80 PRB35-08-80-120

Facility

$4,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270637010N
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 PRO 8X80 PRB35-08-80-120

Facility

$4,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270637010N
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

Know your out-of-pocket cost for care.

All Charges