Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT STSB BIL 10x60 80 C10060

Facility

$7,316.00

Hospital Charge Code	270631415V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,097.40
Max. Negotiated Rate	$1,770.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,463.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,770.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,609.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,097.40

STENT SUP 5X40X120 S05040120G2

Facility

$8,250.00

Hospital Charge Code	270644818C
Hospital Revenue Code	278
Min. Negotiated Rate	$198.82
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$198.82
Rate for Payer: Wellpoint Medicaid Managed Care	$218.62

STENT SUP 5X40X120 S05040120G2

Facility

$8,250.00

Hospital Charge Code	270644818C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

STENT SUPERA 4.5x100MM

Facility

$8,137.50

Service Code	HCPCS C1876
Hospital Charge Code	270671334
Hospital Revenue Code	272
Min. Negotiated Rate	$1,220.62
Max. Negotiated Rate	$1,220.62
Rate for Payer: Qualcare PPO/HMO/WC	$1,220.62

STENT SUPERA 4.5x100MM

Facility

$8,137.50

Service Code	HCPCS C1876
Hospital Charge Code	270671334
Hospital Revenue Code	272
Min. Negotiated Rate	$196.11
Max. Negotiated Rate	$4,068.75
Rate for Payer: Aetna Commercial	$3,092.25
Rate for Payer: Aetna Medicare Advantage	$2,441.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,075.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,075.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,075.06
Rate for Payer: Cigna Commercial	$4,068.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,441.25
Rate for Payer: Oxford Commercial	$1,627.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,220.62
Rate for Payer: UnitedHealthcare Commercial	$1,627.50
Rate for Payer: UnitedHealthcare Community & State	$196.11
Rate for Payer: Wellpoint Medicaid Managed Care	$215.64

STENT SUPERA 4.5x120mm 6F

Facility

$8,805.00

Hospital Charge Code	270705282
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 SUPERA 4.5x120mm 6F

Facility

$9,945.00

Service Code	HCPCS C1876
Hospital Charge Code	270672069
Hospital Revenue Code	278
Min. Negotiated Rate	$1,491.75
Max. Negotiated Rate	$2,406.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,989.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,406.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,187.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,491.75

STENT SUPERA 4.5x120mm 6F

Facility

$9,945.00

Service Code	HCPCS C1876
Hospital Charge Code	270672069
Hospital Revenue Code	278
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) NJ Health	$1,989.00
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	$2,406.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,187.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,491.75
Rate for Payer: UnitedHealthcare Community & State	$239.67
Rate for Payer: Wellpoint Medicaid Managed Care	$263.54

STENT SUPERA 4.5x120mm 6F

Facility

$8,805.00

Hospital Charge Code	270705282
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 SUPERA 4.5x60mm 120cm 6F

Facility

$8,137.50

Service Code	HCPCS C1876
Hospital Charge Code	270670960
Hospital Revenue Code	272
Min. Negotiated Rate	$196.11
Max. Negotiated Rate	$4,068.75
Rate for Payer: Aetna Commercial	$3,092.25
Rate for Payer: Aetna Medicare Advantage	$2,441.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,075.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,075.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,075.06
Rate for Payer: Cigna Commercial	$4,068.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,441.25
Rate for Payer: Oxford Commercial	$1,627.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,220.62
Rate for Payer: UnitedHealthcare Commercial	$1,627.50
Rate for Payer: UnitedHealthcare Community & State	$196.11
Rate for Payer: Wellpoint Medicaid Managed Care	$215.64

STENT SUPERA 4.5x60mm 120cm 6F

Facility

$8,137.50

Service Code	HCPCS C1876
Hospital Charge Code	270670960
Hospital Revenue Code	272
Min. Negotiated Rate	$1,220.62
Max. Negotiated Rate	$1,220.62
Rate for Payer: Qualcare PPO/HMO/WC	$1,220.62

STENT SUPERA 4X100MM 120CM

Facility

$8,250.00

Hospital Charge Code	270644886C
Hospital Revenue Code	278
Min. Negotiated Rate	$198.82
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$198.82
Rate for Payer: Wellpoint Medicaid Managed Care	$218.62

STENT SUPERA 4X100MM 120CM

Facility

$8,250.00

Hospital Charge Code	270644886C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

STENT SUPERA 4X120MM 120CM

Facility

$8,250.00

Hospital Charge Code	270644888C
Hospital Revenue Code	278
Min. Negotiated Rate	$198.82
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$198.82
Rate for Payer: Wellpoint Medicaid Managed Care	$218.62

STENT SUPERA 4X120MM 120CM

Facility

$8,250.00

Hospital Charge Code	270645398C
Hospital Revenue Code	278
Min. Negotiated Rate	$198.82
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$198.82
Rate for Payer: Wellpoint Medicaid Managed Care	$218.62

STENT SUPERA 4X120MM 120CM

Facility

$8,250.00

Hospital Charge Code	270644888C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

STENT SUPERA 4X120MM 120CM

Facility

$8,250.00

Hospital Charge Code	270645398C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

STENT SUPERA 4x60mm 120cm

Facility

$8,805.00

Hospital Charge Code	270644884
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 SUPERA 4x60mm 120cm

Facility

$8,805.00

Hospital Charge Code	270644884
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 SUPERA 4X60MM 120CM

Facility

$8,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270644884C
Hospital Revenue Code	278
Min. Negotiated Rate	$198.82
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$198.82
Rate for Payer: Wellpoint Medicaid Managed Care	$218.62

STENT SUPERA 4X60MM 120CM

Facility

$8,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270644884C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

STENT SUPERA 5.5x100mm 120cm

Facility

$7,750.00

Hospital Charge Code	270670875
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 SUPERA 5.5x100mm 120cm

Facility

$7,750.00

Hospital Charge Code	270670875
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 SUPERA 5.5x100MM 6F

Facility

$8,805.00

Service Code	HCPCS C1876
Hospital Charge Code	270671336
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 SUPERA 5.5x100MM 6F

Facility

$8,805.00

Service Code	HCPCS C1876
Hospital Charge Code	270671336
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

Know your out-of-pocket cost for care.

All Charges