Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT UNIVERSA FIRM 6x22

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647871
Hospital Revenue Code	278
Min. Negotiated Rate	$67.86
Max. Negotiated Rate	$109.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.53
Rate for Payer: Qualcare PPO/HMO/WC	$67.86

STENT UNIVERSA FIRM 6x26

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647873
Hospital Revenue Code	278
Min. Negotiated Rate	$10.90
Max. Negotiated Rate	$226.20
Rate for Payer: Aetna Commercial	$171.91
Rate for Payer: Aetna Medicare Advantage	$135.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.36
Rate for Payer: Cigna Commercial	$226.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.53
Rate for Payer: Qualcare PPO/HMO/WC	$67.86
Rate for Payer: UnitedHealthcare Community & State	$10.90
Rate for Payer: Wellpoint Medicaid Managed Care	$11.99

STENT UNIVERSA FIRM 6x26

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647873
Hospital Revenue Code	278
Min. Negotiated Rate	$67.86
Max. Negotiated Rate	$109.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.53
Rate for Payer: Qualcare PPO/HMO/WC	$67.86

STENT UNIVERSA FIRM 6x28

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647874
Hospital Revenue Code	278
Min. Negotiated Rate	$10.90
Max. Negotiated Rate	$226.20
Rate for Payer: Aetna Commercial	$171.91
Rate for Payer: Aetna Medicare Advantage	$135.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.36
Rate for Payer: Cigna Commercial	$226.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.53
Rate for Payer: Qualcare PPO/HMO/WC	$67.86
Rate for Payer: UnitedHealthcare Community & State	$10.90
Rate for Payer: Wellpoint Medicaid Managed Care	$11.99

STENT UNIVERSA FIRM 6x28

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647874
Hospital Revenue Code	278
Min. Negotiated Rate	$67.86
Max. Negotiated Rate	$109.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.53
Rate for Payer: Qualcare PPO/HMO/WC	$67.86

STENT UNIVERSA SOFT 5FR22-32CM

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647869
Hospital Revenue Code	278
Min. Negotiated Rate	$67.86
Max. Negotiated Rate	$109.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.53
Rate for Payer: Qualcare PPO/HMO/WC	$67.86

STENT UNIVERSA SOFT 5FR22-32CM

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647869
Hospital Revenue Code	278
Min. Negotiated Rate	$10.90
Max. Negotiated Rate	$226.20
Rate for Payer: Aetna Commercial	$171.91
Rate for Payer: Aetna Medicare Advantage	$135.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.36
Rate for Payer: Cigna Commercial	$226.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.53
Rate for Payer: Qualcare PPO/HMO/WC	$67.86
Rate for Payer: UnitedHealthcare Community & State	$10.90
Rate for Payer: Wellpoint Medicaid Managed Care	$11.99

STENT UNIVERSA SOFT 6 24

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647872
Hospital Revenue Code	278
Min. Negotiated Rate	$67.86
Max. Negotiated Rate	$109.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.53
Rate for Payer: Qualcare PPO/HMO/WC	$67.86

STENT UNIVERSA SOFT 6 24

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647872
Hospital Revenue Code	278
Min. Negotiated Rate	$10.90
Max. Negotiated Rate	$226.20
Rate for Payer: Aetna Commercial	$171.91
Rate for Payer: Aetna Medicare Advantage	$135.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.36
Rate for Payer: Cigna Commercial	$226.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.53
Rate for Payer: Qualcare PPO/HMO/WC	$67.86
Rate for Payer: UnitedHealthcare Community & State	$10.90
Rate for Payer: Wellpoint Medicaid Managed Care	$11.99

STENT UNIVERSA SOFT 6FR22-32CM

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647870
Hospital Revenue Code	278
Min. Negotiated Rate	$67.86
Max. Negotiated Rate	$109.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.53
Rate for Payer: Qualcare PPO/HMO/WC	$67.86

STENT UNIVERSA SOFT 6FR22-32CM

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647870
Hospital Revenue Code	278
Min. Negotiated Rate	$10.90
Max. Negotiated Rate	$226.20
Rate for Payer: Aetna Commercial	$171.91
Rate for Payer: Aetna Medicare Advantage	$135.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.36
Rate for Payer: Cigna Commercial	$226.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.53
Rate for Payer: Qualcare PPO/HMO/WC	$67.86
Rate for Payer: UnitedHealthcare Community & State	$10.90
Rate for Payer: Wellpoint Medicaid Managed Care	$11.99

STENT UNIVERSA SOFT7 FR22-32cm

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658545
Hospital Revenue Code	278
Min. Negotiated Rate	$67.86
Max. Negotiated Rate	$109.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.53
Rate for Payer: Qualcare PPO/HMO/WC	$67.86

STENT UNIVERSA SOFT7 FR22-32cm

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658545
Hospital Revenue Code	278
Min. Negotiated Rate	$10.90
Max. Negotiated Rate	$226.20
Rate for Payer: Aetna Commercial	$171.91
Rate for Payer: Aetna Medicare Advantage	$135.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.36
Rate for Payer: Cigna Commercial	$226.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.53
Rate for Payer: Qualcare PPO/HMO/WC	$67.86
Rate for Payer: UnitedHealthcare Community & State	$10.90
Rate for Payer: Wellpoint Medicaid Managed Care	$11.99

STENT, URETERAL

Facility

$924.00

Hospital Charge Code	2008165
Hospital Revenue Code	278
Min. Negotiated Rate	$22.27
Max. Negotiated Rate	$462.00
Rate for Payer: Aetna Commercial	$351.12
Rate for Payer: Aetna Medicare Advantage	$277.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$235.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$235.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$184.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$235.62
Rate for Payer: Cigna Commercial	$462.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$203.28
Rate for Payer: Qualcare PPO/HMO/WC	$138.60
Rate for Payer: UnitedHealthcare Community & State	$22.27
Rate for Payer: Wellpoint Medicaid Managed Care	$24.49

STENT, URETERAL

Facility

$924.00

Hospital Charge Code	2008165
Hospital Revenue Code	278
Min. Negotiated Rate	$138.60
Max. Negotiated Rate	$223.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$184.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$203.28
Rate for Payer: Qualcare PPO/HMO/WC	$138.60

STENT URETERAL 4.7 Fr./22cm-32

Facility

$295.00

Service Code	HCPCS C2617
Hospital Charge Code	270636831
Hospital Revenue Code	278
Min. Negotiated Rate	$7.11
Max. Negotiated Rate	$147.50
Rate for Payer: Aetna Commercial	$112.10
Rate for Payer: Aetna Medicare Advantage	$88.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.22
Rate for Payer: Cigna Commercial	$147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$64.90
Rate for Payer: Qualcare PPO/HMO/WC	$44.25
Rate for Payer: UnitedHealthcare Community & State	$7.11
Rate for Payer: Wellpoint Medicaid Managed Care	$7.82

STENT URETERAL 4.7 Fr./22cm-32

Facility

$295.00

Service Code	HCPCS C2617
Hospital Charge Code	270636831
Hospital Revenue Code	278
Min. Negotiated Rate	$44.25
Max. Negotiated Rate	$71.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$64.90
Rate for Payer: Qualcare PPO/HMO/WC	$44.25

STENT URETERAL 4.7FR X 22CM

Facility

$846.35

Service Code	HCPCS C2617
Hospital Charge Code	270661333
Hospital Revenue Code	278
Min. Negotiated Rate	$126.95
Max. Negotiated Rate	$204.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$186.20
Rate for Payer: Qualcare PPO/HMO/WC	$126.95

STENT URETERAL 4.7FR X 22CM

Facility

$846.35

Service Code	HCPCS C2617
Hospital Charge Code	270661333
Hospital Revenue Code	278
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$423.18
Rate for Payer: Aetna Commercial	$321.61
Rate for Payer: Aetna Medicare Advantage	$253.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.82
Rate for Payer: Cigna Commercial	$423.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$186.20
Rate for Payer: Qualcare PPO/HMO/WC	$126.95
Rate for Payer: UnitedHealthcare Community & State	$20.40
Rate for Payer: Wellpoint Medicaid Managed Care	$22.43

STENT URETERAL 6FRX22

Facility

$425.00

Service Code	HCPCS C2617
Hospital Charge Code	270660561
Hospital Revenue Code	278
Min. Negotiated Rate	$10.24
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$93.50
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Community & State	$10.24
Rate for Payer: Wellpoint Medicaid Managed Care	$11.26

STENT URETERAL 6FRX22

Facility

$425.00

Service Code	HCPCS C2617
Hospital Charge Code	270660561
Hospital Revenue Code	278
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$102.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$93.50
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

STENT URETERAL 7FR 30CM SET

Facility

$816.00

Hospital Charge Code	270331430
Hospital Revenue Code	278
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$197.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$179.52
Rate for Payer: Qualcare PPO/HMO/WC	$122.40

STENT URETERAL 7FR 30CM SET

Facility

$816.00

Hospital Charge Code	270331430
Hospital Revenue Code	278
Min. Negotiated Rate	$19.67
Max. Negotiated Rate	$408.00
Rate for Payer: Aetna Commercial	$310.08
Rate for Payer: Aetna Medicare Advantage	$244.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$208.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$208.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$208.08
Rate for Payer: Cigna Commercial	$408.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$179.52
Rate for Payer: Qualcare PPO/HMO/WC	$122.40
Rate for Payer: UnitedHealthcare Community & State	$19.67
Rate for Payer: Wellpoint Medicaid Managed Care	$21.62

STENT URETERAL 8FR 30CM SET

Facility

$971.00

Hospital Charge Code	270331431
Hospital Revenue Code	278
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$485.50
Rate for Payer: Aetna Commercial	$368.98
Rate for Payer: Aetna Medicare Advantage	$291.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$247.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$247.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$194.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$247.60
Rate for Payer: Cigna Commercial	$485.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$234.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$213.62
Rate for Payer: Qualcare PPO/HMO/WC	$145.65
Rate for Payer: UnitedHealthcare Community & State	$23.40
Rate for Payer: Wellpoint Medicaid Managed Care	$25.73

STENT URETERAL 8FR 30CM SET

Facility

$971.00

Hospital Charge Code	270331431
Hospital Revenue Code	278
Min. Negotiated Rate	$145.65
Max. Negotiated Rate	$234.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$194.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$234.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$213.62
Rate for Payer: Qualcare PPO/HMO/WC	$145.65

Know your out-of-pocket cost for care.

All Charges