Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT RX ACCULINK 6X40X132CM

Facility

$10,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270645078C
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 RX ACCULINK 6X40X132CM

Facility

$10,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270645078C
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 RX BILIARY 10Fx5cm 4560

Facility

$640.00

Service Code	HCPCS C2625
Hospital Charge Code	270630046
Hospital Revenue Code	278
Min. Negotiated Rate	$15.42
Max. Negotiated Rate	$320.00
Rate for Payer: Aetna Commercial	$243.20
Rate for Payer: Aetna Medicare Advantage	$192.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$128.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.20
Rate for Payer: Cigna Commercial	$320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$140.80
Rate for Payer: Qualcare PPO/HMO/WC	$96.00
Rate for Payer: UnitedHealthcare Community & State	$15.42
Rate for Payer: Wellpoint Medicaid Managed Care	$16.96

STENT RX BILIARY 10Fx5cm 4560

Facility

$640.00

Service Code	HCPCS C2625
Hospital Charge Code	270630046
Hospital Revenue Code	278
Min. Negotiated Rate	$96.00
Max. Negotiated Rate	$154.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$128.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$140.80
Rate for Payer: Qualcare PPO/HMO/WC	$96.00

STENT RX BILIARY 7x10cm 4557

Facility

$580.40

Service Code	HCPCS C2625
Hospital Charge Code	270630322
Hospital Revenue Code	278
Min. Negotiated Rate	$87.06
Max. Negotiated Rate	$140.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$127.69
Rate for Payer: Qualcare PPO/HMO/WC	$87.06

STENT RX BILIARY 7x10cm 4557

Facility

$580.40

Service Code	HCPCS C2625
Hospital Charge Code	270630322
Hospital Revenue Code	278
Min. Negotiated Rate	$13.99
Max. Negotiated Rate	$290.20
Rate for Payer: Aetna Commercial	$220.55
Rate for Payer: Aetna Medicare Advantage	$174.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$148.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$148.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$148.00
Rate for Payer: Cigna Commercial	$290.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$127.69
Rate for Payer: Qualcare PPO/HMO/WC	$87.06
Rate for Payer: UnitedHealthcare Community & State	$13.99
Rate for Payer: Wellpoint Medicaid Managed Care	$15.38

STENT RX BILIARY 7x7cm 4556

Facility

$456.00

Service Code	HCPCS C2625
Hospital Charge Code	270630321
Hospital Revenue Code	278
Min. Negotiated Rate	$10.99
Max. Negotiated Rate	$228.00
Rate for Payer: Aetna Commercial	$173.28
Rate for Payer: Aetna Medicare Advantage	$136.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$116.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$116.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$116.28
Rate for Payer: Cigna Commercial	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$100.32
Rate for Payer: Qualcare PPO/HMO/WC	$68.40
Rate for Payer: UnitedHealthcare Community & State	$10.99
Rate for Payer: Wellpoint Medicaid Managed Care	$12.08

STENT RX BILIARY 7x7cm 4556

Facility

$456.00

Service Code	HCPCS C2625
Hospital Charge Code	270630321
Hospital Revenue Code	278
Min. Negotiated Rate	$68.40
Max. Negotiated Rate	$110.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$100.32
Rate for Payer: Qualcare PPO/HMO/WC	$68.40

STENT RX BILIARY 8.5 x 12 4568

Facility

$580.40

Hospital Charge Code	270630045
Hospital Revenue Code	278
Min. Negotiated Rate	$13.99
Max. Negotiated Rate	$290.20
Rate for Payer: Aetna Commercial	$220.55
Rate for Payer: Aetna Medicare Advantage	$174.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$148.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$148.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$148.00
Rate for Payer: Cigna Commercial	$290.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$127.69
Rate for Payer: Qualcare PPO/HMO/WC	$87.06
Rate for Payer: UnitedHealthcare Community & State	$13.99
Rate for Payer: Wellpoint Medicaid Managed Care	$15.38

STENT RX BILIARY 8.5 x 12 4568

Facility

$580.40

Hospital Charge Code	270630045
Hospital Revenue Code	278
Min. Negotiated Rate	$87.06
Max. Negotiated Rate	$140.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$127.69
Rate for Payer: Qualcare PPO/HMO/WC	$87.06

STENT RX EXPEDITION 2 75X15

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658767S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT RX EXPEDITION 2 75X15

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658767
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT RX EXPEDITION 2 75X15

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658767
Hospital Revenue Code	278
Min. Negotiated Rate	$168.70
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,660.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$168.70
Rate for Payer: Wellpoint Medicaid Managed Care	$185.50

STENT RX EXPEDITION 2 75X15

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658767S
Hospital Revenue Code	278
Min. Negotiated Rate	$168.70
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,660.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$168.70
Rate for Payer: Wellpoint Medicaid Managed Care	$185.50

STENT RX ULTRA 4.5X13MM

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270666367
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

STENT RX ULTRA 4.5X13MM

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270666367
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

STENT RX XP 2.25X08 1074225-08

Facility

$7,000.00

Hospital Charge Code	270658750C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT RX XP 2.25X08 1074225-08

Facility

$7,000.00

Hospital Charge Code	270658750C
Hospital Revenue Code	278
Min. Negotiated Rate	$168.70
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,660.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$168.70
Rate for Payer: Wellpoint Medicaid Managed Care	$185.50

STENT RX XP 2.25X12 1074225-12

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658752C
Hospital Revenue Code	278
Min. Negotiated Rate	$168.70
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,660.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$168.70
Rate for Payer: Wellpoint Medicaid Managed Care	$185.50

STENT RX XP 2.25X12 1074225-12

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658752C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT RX XP 2.25X15 1074225-18

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658753S
Hospital Revenue Code	278
Min. Negotiated Rate	$168.70
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,660.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$168.70
Rate for Payer: Wellpoint Medicaid Managed Care	$185.50

STENT RX XP 2.25X15 1074225-18

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658753C
Hospital Revenue Code	278
Min. Negotiated Rate	$168.70
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,660.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$168.70
Rate for Payer: Wellpoint Medicaid Managed Care	$185.50

STENT RX XP 2.25X15 1074225-18

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658753C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT RX XP 2.25X15 1074225-18

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658753S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT RX XP 2.25X18 1074225-18

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658754C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

Know your out-of-pocket cost for care.

All Charges