Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT SUPERA 6.0x100MM

Facility

$8,805.00

Service Code	HCPCS C1876
Hospital Charge Code	270689717
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 6.0x120MM 120CM

Facility

$8,137.50

Service Code	HCPCS C1876
Hospital Charge Code	270677404
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 6.0x120MM 120CM

Facility

$8,137.50

Service Code	HCPCS C1876
Hospital Charge Code	270677404
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 6.0x150x120 6F

Facility

$8,137.50

Hospital Charge Code	270705284
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 6.0x150x120 6F

Facility

$8,137.50

Hospital Charge Code	270705284
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 6.0x40x120 6F

Facility

$8,137.50

Hospital Charge Code	270705285
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 6.0x40x120 6F

Facility

$8,137.50

Hospital Charge Code	270705285
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 6.0x80x120 6F

Facility

$8,137.50

Hospital Charge Code	270705286
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 6.0x80x120 6F

Facility

$8,137.50

Hospital Charge Code	270705286
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 6.5x120MM 120CM

Facility

$8,137.50

Service Code	HCPCS C1876
Hospital Charge Code	270675916
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 6.5x120MM 120CM

Facility

$8,137.50

Service Code	HCPCS C1876
Hospital Charge Code	270675916
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 6.5x150MM 120CM

Facility

$8,137.50

Service Code	HCPCS C1876
Hospital Charge Code	270675917
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 6.5x150MM 120CM

Facility

$8,137.50

Service Code	HCPCS C1876
Hospital Charge Code	270675917
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 6.5x40x 120 6F

Facility

$8,137.50

Hospital Charge Code	270705287
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 6.5x40x 120 6F

Facility

$8,137.50

Hospital Charge Code	270705287
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 6.5x40x120 6F

Facility

$8,137.50

Hospital Charge Code	270705288
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 6.5x40x120 6F

Facility

$8,137.50

Hospital Charge Code	270705288
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 6.5x80MM 120CM

Facility

$8,137.50

Service Code	HCPCS C1876
Hospital Charge Code	270675915
Hospital Revenue Code	278
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) NJ Health	$1,627.50
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	$1,969.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,790.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,220.62
Rate for Payer: UnitedHealthcare Community & State	$196.11
Rate for Payer: Wellpoint Medicaid Managed Care	$215.64

STENT SUPERA 6.5x80MM 120CM

Facility

$8,137.50

Service Code	HCPCS C1876
Hospital Charge Code	270675915
Hospital Revenue Code	278
Min. Negotiated Rate	$1,220.62
Max. Negotiated Rate	$1,969.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,627.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,969.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,790.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,220.62

STENT SUPERA 6X100MM 120CM

Facility

$8,250.00

Hospital Charge Code	270644887C
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 6X100MM 120CM

Facility

$8,250.00

Hospital Charge Code	270644887C
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 6X100MM 120CM

Facility

$8,250.00

Hospital Charge Code	270644887
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 6X100MM 120CM

Facility

$8,250.00

Hospital Charge Code	270644887
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 6X120MM 120CM

Facility

$8,250.00

Hospital Charge Code	270644889
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 6X120MM 120CM

Facility

$8,250.00

Hospital Charge Code	270644889
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

Know your out-of-pocket cost for care.

All Charges