Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT URETERAL CONTOUR 6Fx20cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684752
Hospital Revenue Code	278
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$262.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$238.92
Rate for Payer: Qualcare PPO/HMO/WC	$162.90

STENT URETERAL CONTOUR 6Fx20cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684752
Hospital Revenue Code	278
Min. Negotiated Rate	$26.17
Max. Negotiated Rate	$543.00
Rate for Payer: Aetna Commercial	$412.68
Rate for Payer: Aetna Medicare Advantage	$325.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$276.93
Rate for Payer: Cigna Commercial	$543.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$238.92
Rate for Payer: Qualcare PPO/HMO/WC	$162.90
Rate for Payer: UnitedHealthcare Community & State	$26.17
Rate for Payer: Wellpoint Medicaid Managed Care	$28.78

STENT URETERAL CONTOUR 6Fx22cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684753
Hospital Revenue Code	278
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$262.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$238.92
Rate for Payer: Qualcare PPO/HMO/WC	$162.90

STENT URETERAL CONTOUR 6Fx22cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684753
Hospital Revenue Code	278
Min. Negotiated Rate	$26.17
Max. Negotiated Rate	$543.00
Rate for Payer: Aetna Commercial	$412.68
Rate for Payer: Aetna Medicare Advantage	$325.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$276.93
Rate for Payer: Cigna Commercial	$543.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$238.92
Rate for Payer: Qualcare PPO/HMO/WC	$162.90
Rate for Payer: UnitedHealthcare Community & State	$26.17
Rate for Payer: Wellpoint Medicaid Managed Care	$28.78

STENT URETERAL CONTOUR 6Fx24cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684754
Hospital Revenue Code	278
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$262.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$238.92
Rate for Payer: Qualcare PPO/HMO/WC	$162.90

STENT URETERAL CONTOUR 6Fx24cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684754
Hospital Revenue Code	278
Min. Negotiated Rate	$26.17
Max. Negotiated Rate	$543.00
Rate for Payer: Aetna Commercial	$412.68
Rate for Payer: Aetna Medicare Advantage	$325.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$276.93
Rate for Payer: Cigna Commercial	$543.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$238.92
Rate for Payer: Qualcare PPO/HMO/WC	$162.90
Rate for Payer: UnitedHealthcare Community & State	$26.17
Rate for Payer: Wellpoint Medicaid Managed Care	$28.78

STENT URETERAL CONTOUR 6Fx26cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684755
Hospital Revenue Code	278
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$262.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$238.92
Rate for Payer: Qualcare PPO/HMO/WC	$162.90

STENT URETERAL CONTOUR 6Fx26cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684755
Hospital Revenue Code	278
Min. Negotiated Rate	$26.17
Max. Negotiated Rate	$543.00
Rate for Payer: Aetna Commercial	$412.68
Rate for Payer: Aetna Medicare Advantage	$325.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$276.93
Rate for Payer: Cigna Commercial	$543.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$238.92
Rate for Payer: Qualcare PPO/HMO/WC	$162.90
Rate for Payer: UnitedHealthcare Community & State	$26.17
Rate for Payer: Wellpoint Medicaid Managed Care	$28.78

STENT URETERAL CONTOUR 6Fx28cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684756
Hospital Revenue Code	278
Min. Negotiated Rate	$26.17
Max. Negotiated Rate	$543.00
Rate for Payer: Aetna Commercial	$412.68
Rate for Payer: Aetna Medicare Advantage	$325.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$276.93
Rate for Payer: Cigna Commercial	$543.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$238.92
Rate for Payer: Qualcare PPO/HMO/WC	$162.90
Rate for Payer: UnitedHealthcare Community & State	$26.17
Rate for Payer: Wellpoint Medicaid Managed Care	$28.78

STENT URETERAL CONTOUR 6Fx28cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684756
Hospital Revenue Code	278
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$262.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$238.92
Rate for Payer: Qualcare PPO/HMO/WC	$162.90

STENT URETERAL CONTOUR 6Fx30cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684757
Hospital Revenue Code	278
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$262.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$238.92
Rate for Payer: Qualcare PPO/HMO/WC	$162.90

STENT URETERAL CONTOUR 6Fx30cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684757
Hospital Revenue Code	278
Min. Negotiated Rate	$26.17
Max. Negotiated Rate	$543.00
Rate for Payer: Aetna Commercial	$412.68
Rate for Payer: Aetna Medicare Advantage	$325.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$276.93
Rate for Payer: Cigna Commercial	$543.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$238.92
Rate for Payer: Qualcare PPO/HMO/WC	$162.90
Rate for Payer: UnitedHealthcare Community & State	$26.17
Rate for Payer: Wellpoint Medicaid Managed Care	$28.78

STENT URETERAL CONTOUR 8Fx20cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684758
Hospital Revenue Code	278
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$262.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$238.92
Rate for Payer: Qualcare PPO/HMO/WC	$162.90

STENT URETERAL CONTOUR 8Fx20cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684758
Hospital Revenue Code	278
Min. Negotiated Rate	$26.17
Max. Negotiated Rate	$543.00
Rate for Payer: Aetna Commercial	$412.68
Rate for Payer: Aetna Medicare Advantage	$325.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$276.93
Rate for Payer: Cigna Commercial	$543.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$238.92
Rate for Payer: Qualcare PPO/HMO/WC	$162.90
Rate for Payer: UnitedHealthcare Community & State	$26.17
Rate for Payer: Wellpoint Medicaid Managed Care	$28.78

STENT URETERAL CONTOUR 8Fx22cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684759
Hospital Revenue Code	278
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$262.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$238.92
Rate for Payer: Qualcare PPO/HMO/WC	$162.90

STENT URETERAL CONTOUR 8Fx22cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684759
Hospital Revenue Code	278
Min. Negotiated Rate	$26.17
Max. Negotiated Rate	$543.00
Rate for Payer: Aetna Commercial	$412.68
Rate for Payer: Aetna Medicare Advantage	$325.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$276.93
Rate for Payer: Cigna Commercial	$543.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$238.92
Rate for Payer: Qualcare PPO/HMO/WC	$162.90
Rate for Payer: UnitedHealthcare Community & State	$26.17
Rate for Payer: Wellpoint Medicaid Managed Care	$28.78

STENT URETERAL CONTOUR 8Fx24cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684760
Hospital Revenue Code	278
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$262.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$238.92
Rate for Payer: Qualcare PPO/HMO/WC	$162.90

STENT URETERAL CONTOUR 8Fx24cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684760
Hospital Revenue Code	278
Min. Negotiated Rate	$26.17
Max. Negotiated Rate	$543.00
Rate for Payer: Aetna Commercial	$412.68
Rate for Payer: Aetna Medicare Advantage	$325.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$276.93
Rate for Payer: Cigna Commercial	$543.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$238.92
Rate for Payer: Qualcare PPO/HMO/WC	$162.90
Rate for Payer: UnitedHealthcare Community & State	$26.17
Rate for Payer: Wellpoint Medicaid Managed Care	$28.78

STENT URETERAL CONTOUR 8Fx26cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684761
Hospital Revenue Code	278
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$262.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$238.92
Rate for Payer: Qualcare PPO/HMO/WC	$162.90

STENT URETERAL CONTOUR 8Fx26cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684761
Hospital Revenue Code	278
Min. Negotiated Rate	$26.17
Max. Negotiated Rate	$543.00
Rate for Payer: Aetna Commercial	$412.68
Rate for Payer: Aetna Medicare Advantage	$325.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$276.93
Rate for Payer: Cigna Commercial	$543.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$238.92
Rate for Payer: Qualcare PPO/HMO/WC	$162.90
Rate for Payer: UnitedHealthcare Community & State	$26.17
Rate for Payer: Wellpoint Medicaid Managed Care	$28.78

STENT URETERAL CONTOUR 8Fx28cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684762
Hospital Revenue Code	278
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$262.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$238.92
Rate for Payer: Qualcare PPO/HMO/WC	$162.90

STENT URETERAL CONTOUR 8Fx28cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684762
Hospital Revenue Code	278
Min. Negotiated Rate	$26.17
Max. Negotiated Rate	$543.00
Rate for Payer: Aetna Commercial	$412.68
Rate for Payer: Aetna Medicare Advantage	$325.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$276.93
Rate for Payer: Cigna Commercial	$543.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$238.92
Rate for Payer: Qualcare PPO/HMO/WC	$162.90
Rate for Payer: UnitedHealthcare Community & State	$26.17
Rate for Payer: Wellpoint Medicaid Managed Care	$28.78

STENT URETERAL CONTOUR 8Fx30cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684763
Hospital Revenue Code	278
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$262.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$238.92
Rate for Payer: Qualcare PPO/HMO/WC	$162.90

STENT URETERAL CONTOUR 8Fx30cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684763
Hospital Revenue Code	278
Min. Negotiated Rate	$26.17
Max. Negotiated Rate	$543.00
Rate for Payer: Aetna Commercial	$412.68
Rate for Payer: Aetna Medicare Advantage	$325.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$276.93
Rate for Payer: Cigna Commercial	$543.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$238.92
Rate for Payer: Qualcare PPO/HMO/WC	$162.90
Rate for Payer: UnitedHealthcare Community & State	$26.17
Rate for Payer: Wellpoint Medicaid Managed Care	$28.78

STENT URETERAL INLAY 22-32CM

Facility

$429.05

Service Code	HCPCS C2625
Hospital Charge Code	270689491
Hospital Revenue Code	278
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$214.53
Rate for Payer: Aetna Commercial	$163.04
Rate for Payer: Aetna Medicare Advantage	$128.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.41
Rate for Payer: Cigna Commercial	$214.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$94.39
Rate for Payer: Qualcare PPO/HMO/WC	$64.36
Rate for Payer: UnitedHealthcare Community & State	$10.34
Rate for Payer: Wellpoint Medicaid Managed Care	$11.37

Know your out-of-pocket cost for care.

All Charges