Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT SYMPHY 7F 14x40x75 60362

Facility

$5,596.80

Hospital Charge Code	270626880V
Hospital Revenue Code	278
Min. Negotiated Rate	$839.52
Max. Negotiated Rate	$1,354.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,119.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,354.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,231.30
Rate for Payer: Qualcare PPO/HMO/WC	$839.52

STENT SYMPHY 7F 14x40x75 60362

Facility

$5,596.80

Hospital Charge Code	270626880V
Hospital Revenue Code	278
Min. Negotiated Rate	$134.88
Max. Negotiated Rate	$2,798.40
Rate for Payer: Aetna Commercial	$2,126.78
Rate for Payer: Aetna Medicare Advantage	$1,679.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,427.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,427.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,119.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,427.18
Rate for Payer: Cigna Commercial	$2,798.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,354.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,231.30
Rate for Payer: Qualcare PPO/HMO/WC	$839.52
Rate for Payer: UnitedHealthcare Community & State	$134.88
Rate for Payer: Wellpoint Medicaid Managed Care	$148.32

STENT SYMPHY 7F 14x40x75 60362

Facility

$5,552.10

Hospital Charge Code	270626880
Hospital Revenue Code	278
Min. Negotiated Rate	$832.82
Max. Negotiated Rate	$1,343.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,221.46
Rate for Payer: Qualcare PPO/HMO/WC	$832.82

STENT SYS ACLINK CAR 101134030

Facility

$10,168.00

Hospital Charge Code	270635100
Hospital Revenue Code	278
Min. Negotiated Rate	$1,525.20
Max. Negotiated Rate	$2,460.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,033.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,460.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,236.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,525.20

STENT SYS ACLINK CAR 101134030

Facility

$10,168.00

Hospital Charge Code	270635100V
Hospital Revenue Code	278
Min. Negotiated Rate	$245.05
Max. Negotiated Rate	$5,084.00
Rate for Payer: Aetna Commercial	$3,863.84
Rate for Payer: Aetna Medicare Advantage	$3,050.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,592.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,592.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,033.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,592.84
Rate for Payer: Cigna Commercial	$5,084.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,460.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,236.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,525.20
Rate for Payer: UnitedHealthcare Community & State	$245.05
Rate for Payer: Wellpoint Medicaid Managed Care	$269.45

STENT SYS ACLINK CAR 101134030

Facility

$10,168.00

Hospital Charge Code	270635100V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,525.20
Max. Negotiated Rate	$2,460.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,033.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,460.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,236.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,525.20

STENT SYS ACLINK CAR 101134030

Facility

$10,168.00

Hospital Charge Code	270635100
Hospital Revenue Code	278
Min. Negotiated Rate	$245.05
Max. Negotiated Rate	$5,084.00
Rate for Payer: Aetna Commercial	$3,863.84
Rate for Payer: Aetna Medicare Advantage	$3,050.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,592.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,592.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,033.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,592.84
Rate for Payer: Cigna Commercial	$5,084.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,460.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,236.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,525.20
Rate for Payer: UnitedHealthcare Community & State	$245.05
Rate for Payer: Wellpoint Medicaid Managed Care	$269.45

STENT SYSTEM 6F 6x100MM

Facility

$5,375.00

Service Code	HCPCS C1876
Hospital Charge Code	270672788
Hospital Revenue Code	278
Min. Negotiated Rate	$806.25
Max. Negotiated Rate	$1,300.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,182.50
Rate for Payer: Qualcare PPO/HMO/WC	$806.25

STENT SYSTEM 6F 6x100MM

Facility

$5,375.00

Service Code	HCPCS C1876
Hospital Charge Code	270672788
Hospital Revenue Code	278
Min. Negotiated Rate	$129.54
Max. Negotiated Rate	$2,687.50
Rate for Payer: Aetna Commercial	$2,042.50
Rate for Payer: Aetna Medicare Advantage	$1,612.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,370.62
Rate for Payer: Cigna Commercial	$2,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,182.50
Rate for Payer: Qualcare PPO/HMO/WC	$806.25
Rate for Payer: UnitedHealthcare Community & State	$129.54
Rate for Payer: Wellpoint Medicaid Managed Care	$142.44

STENT SYSTEM 6F 6x120MM

Facility

$5,375.00

Service Code	HCPCS C1876
Hospital Charge Code	270672787
Hospital Revenue Code	278
Min. Negotiated Rate	$129.54
Max. Negotiated Rate	$2,687.50
Rate for Payer: Aetna Commercial	$2,042.50
Rate for Payer: Aetna Medicare Advantage	$1,612.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,370.62
Rate for Payer: Cigna Commercial	$2,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,182.50
Rate for Payer: Qualcare PPO/HMO/WC	$806.25
Rate for Payer: UnitedHealthcare Community & State	$129.54
Rate for Payer: Wellpoint Medicaid Managed Care	$142.44

STENT SYSTEM 6F 6x120MM

Facility

$5,375.00

Service Code	HCPCS C1876
Hospital Charge Code	270672787
Hospital Revenue Code	278
Min. Negotiated Rate	$806.25
Max. Negotiated Rate	$1,300.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,182.50
Rate for Payer: Qualcare PPO/HMO/WC	$806.25

STENT SYSTEM 6F 6x40MM

Facility

$5,375.00

Service Code	HCPCS C1876
Hospital Charge Code	270669992
Hospital Revenue Code	278
Min. Negotiated Rate	$129.54
Max. Negotiated Rate	$2,687.50
Rate for Payer: Aetna Commercial	$2,042.50
Rate for Payer: Aetna Medicare Advantage	$1,612.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,370.62
Rate for Payer: Cigna Commercial	$2,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,182.50
Rate for Payer: Qualcare PPO/HMO/WC	$806.25
Rate for Payer: UnitedHealthcare Community & State	$129.54
Rate for Payer: Wellpoint Medicaid Managed Care	$142.44

STENT SYSTEM 6F 6x40MM

Facility

$5,375.00

Service Code	HCPCS C1876
Hospital Charge Code	270669992
Hospital Revenue Code	278
Min. Negotiated Rate	$806.25
Max. Negotiated Rate	$1,300.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,182.50
Rate for Payer: Qualcare PPO/HMO/WC	$806.25

STENT SYSTEM 75CM SHAFT 8x40MM

Facility

$5,375.00

Service Code	HCPCS C1876
Hospital Charge Code	270673632
Hospital Revenue Code	278
Min. Negotiated Rate	$806.25
Max. Negotiated Rate	$1,300.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,182.50
Rate for Payer: Qualcare PPO/HMO/WC	$806.25

STENT SYSTEM 75CM SHAFT 8x40MM

Facility

$5,375.00

Service Code	HCPCS C1876
Hospital Charge Code	270673632
Hospital Revenue Code	278
Min. Negotiated Rate	$129.54
Max. Negotiated Rate	$2,687.50
Rate for Payer: Aetna Commercial	$2,042.50
Rate for Payer: Aetna Medicare Advantage	$1,612.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,370.62
Rate for Payer: Cigna Commercial	$2,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,182.50
Rate for Payer: Qualcare PPO/HMO/WC	$806.25
Rate for Payer: UnitedHealthcare Community & State	$129.54
Rate for Payer: Wellpoint Medicaid Managed Care	$142.44

STENT SYSTEM 7F 7x120MM

Facility

$5,375.00

Service Code	HCPCS C1876
Hospital Charge Code	270673901
Hospital Revenue Code	278
Min. Negotiated Rate	$129.54
Max. Negotiated Rate	$2,687.50
Rate for Payer: Aetna Commercial	$2,042.50
Rate for Payer: Aetna Medicare Advantage	$1,612.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,370.62
Rate for Payer: Cigna Commercial	$2,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,182.50
Rate for Payer: Qualcare PPO/HMO/WC	$806.25
Rate for Payer: UnitedHealthcare Community & State	$129.54
Rate for Payer: Wellpoint Medicaid Managed Care	$142.44

STENT SYSTEM 7F 7x120MM

Facility

$5,375.00

Service Code	HCPCS C1876
Hospital Charge Code	270673901
Hospital Revenue Code	278
Min. Negotiated Rate	$806.25
Max. Negotiated Rate	$1,300.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,182.50
Rate for Payer: Qualcare PPO/HMO/WC	$806.25

STENT SYSTEM 8MM X 57MM

Facility

$5,198.90

Service Code	HCPCS C1876
Hospital Charge Code	270659826
Hospital Revenue Code	278
Min. Negotiated Rate	$779.84
Max. Negotiated Rate	$1,258.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,039.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,258.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,143.76
Rate for Payer: Qualcare PPO/HMO/WC	$779.84

STENT SYSTEM 8MM X 57MM

Facility

$5,198.90

Service Code	HCPCS C1876
Hospital Charge Code	270659826
Hospital Revenue Code	278
Min. Negotiated Rate	$125.29
Max. Negotiated Rate	$2,599.45
Rate for Payer: Aetna Commercial	$1,975.58
Rate for Payer: Aetna Medicare Advantage	$1,559.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,325.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,325.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,039.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,325.72
Rate for Payer: Cigna Commercial	$2,599.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,258.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,143.76
Rate for Payer: Qualcare PPO/HMO/WC	$779.84
Rate for Payer: UnitedHealthcare Community & State	$125.29
Rate for Payer: Wellpoint Medicaid Managed Care	$137.77

STENT SYSTEM 8MM X 57MM

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270659826N
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 SYSTEM 8MM X 57MM

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270659826N
Hospital Revenue Code	278
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
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
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

STENT SYSTEM CENTER 10/3.3 5CM

Facility

$661.15

Hospital Charge Code	270674003
Hospital Revenue Code	278
Min. Negotiated Rate	$15.93
Max. Negotiated Rate	$330.57
Rate for Payer: Aetna Commercial	$251.24
Rate for Payer: Aetna Medicare Advantage	$198.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.59
Rate for Payer: Cigna Commercial	$330.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$145.45
Rate for Payer: Qualcare PPO/HMO/WC	$99.17
Rate for Payer: UnitedHealthcare Community & State	$15.93
Rate for Payer: Wellpoint Medicaid Managed Care	$17.52

STENT SYSTEM CENTER 10/3.3 5CM

Facility

$661.15

Hospital Charge Code	270674003
Hospital Revenue Code	278
Min. Negotiated Rate	$99.17
Max. Negotiated Rate	$160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$145.45
Rate for Payer: Qualcare PPO/HMO/WC	$99.17

STENT SYSTEM CENTER 7/3.3 9CM

Facility

$661.15

Hospital Charge Code	270674004
Hospital Revenue Code	278
Min. Negotiated Rate	$15.93
Max. Negotiated Rate	$330.57
Rate for Payer: Aetna Commercial	$251.24
Rate for Payer: Aetna Medicare Advantage	$198.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.59
Rate for Payer: Cigna Commercial	$330.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$145.45
Rate for Payer: Qualcare PPO/HMO/WC	$99.17
Rate for Payer: UnitedHealthcare Community & State	$15.93
Rate for Payer: Wellpoint Medicaid Managed Care	$17.52

STENT SYSTEM CENTER 7/3.3 9CM

Facility

$661.15

Hospital Charge Code	270674004
Hospital Revenue Code	278
Min. Negotiated Rate	$99.17
Max. Negotiated Rate	$160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$145.45
Rate for Payer: Qualcare PPO/HMO/WC	$99.17

Know your out-of-pocket cost for care.

All Charges