Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT URETERAL INLAY 22-32CM

Facility

$429.05

Service Code	HCPCS C2625
Hospital Charge Code	270689491
Hospital Revenue Code	278
Min. Negotiated Rate	$64.36
Max. Negotiated Rate	$103.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.81
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

STENT URETERAL OPTIMA 7FR 24CM

Facility

$0.05

Service Code	HCPCS C2617FB
Hospital Charge Code	270700827
Hospital Revenue Code	278
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna Commercial	$0.02
Rate for Payer: Aetna Medicare Advantage	$0.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.01
Rate for Payer: Cigna Commercial	$0.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.01
Rate for Payer: Qualcare PPO/HMO/WC	$0.01
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

STENT URETERAL OPTIMA 7FR 24CM

Facility

$0.05

Service Code	HCPCS C2617FB
Hospital Charge Code	270700827
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.01
Rate for Payer: Qualcare PPO/HMO/WC	$0.01

STENT URETERAL SET

Facility

$700.00

Service Code	HCPCS C2617
Hospital Charge Code	270658504
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$169.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$154.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

STENT URETERAL SET

Facility

$700.00

Service Code	HCPCS C2617
Hospital Charge Code	270658504
Hospital Revenue Code	278
Min. Negotiated Rate	$16.87
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$266.00
Rate for Payer: Aetna Medicare Advantage	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.50
Rate for Payer: Cigna Commercial	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$154.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00
Rate for Payer: UnitedHealthcare Community & State	$16.87
Rate for Payer: Wellpoint Medicaid Managed Care	$18.55

STENT URETERAL SOFT 5FR 22CM

Facility

$493.25

Hospital Charge Code	270657637
Hospital Revenue Code	278
Min. Negotiated Rate	$11.89
Max. Negotiated Rate	$246.62
Rate for Payer: Aetna Commercial	$187.44
Rate for Payer: Aetna Medicare Advantage	$147.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$125.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$125.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$98.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$125.78
Rate for Payer: Cigna Commercial	$246.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$108.52
Rate for Payer: Qualcare PPO/HMO/WC	$73.99
Rate for Payer: UnitedHealthcare Community & State	$11.89
Rate for Payer: Wellpoint Medicaid Managed Care	$13.07

STENT URETERAL SOFT 5FR 22CM

Facility

$493.25

Hospital Charge Code	270657637
Hospital Revenue Code	278
Min. Negotiated Rate	$73.99
Max. Negotiated Rate	$119.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$98.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$108.52
Rate for Payer: Qualcare PPO/HMO/WC	$73.99

STENT URETERAL SOFT 7.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658590
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 SOFT 7.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658590
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 URETERAL SOFT 7.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658589
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 URETERAL SOFT 7.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658589
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 SOFT 7.0FR 22CM

Facility

$406.25

Service Code	HCPCS C2617
Hospital Charge Code	270658588
Hospital Revenue Code	278
Min. Negotiated Rate	$60.94
Max. Negotiated Rate	$98.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$89.38
Rate for Payer: Qualcare PPO/HMO/WC	$60.94

STENT URETERAL SOFT 7.0FR 22CM

Facility

$406.25

Service Code	HCPCS C2617
Hospital Charge Code	270658588
Hospital Revenue Code	278
Min. Negotiated Rate	$9.79
Max. Negotiated Rate	$203.12
Rate for Payer: Aetna Commercial	$154.38
Rate for Payer: Aetna Medicare Advantage	$121.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.59
Rate for Payer: Cigna Commercial	$203.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$89.38
Rate for Payer: Qualcare PPO/HMO/WC	$60.94
Rate for Payer: UnitedHealthcare Community & State	$9.79
Rate for Payer: Wellpoint Medicaid Managed Care	$10.77

STENT URETERAL SOFT 8.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658594
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 SOFT 8.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658594
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 URETERAL VL 6F 22-30 CM

Facility

$1,162.85

Service Code	HCPCS C2617
Hospital Charge Code	270689651
Hospital Revenue Code	278
Min. Negotiated Rate	$174.43
Max. Negotiated Rate	$281.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$255.83
Rate for Payer: Qualcare PPO/HMO/WC	$174.43

STENT URETERAL VL 6F 22-30 CM

Facility

$1,162.85

Service Code	HCPCS C2617
Hospital Charge Code	270689651
Hospital Revenue Code	278
Min. Negotiated Rate	$28.02
Max. Negotiated Rate	$581.42
Rate for Payer: Aetna Commercial	$441.88
Rate for Payer: Aetna Medicare Advantage	$348.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$296.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$296.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$296.53
Rate for Payer: Cigna Commercial	$581.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$255.83
Rate for Payer: Qualcare PPO/HMO/WC	$174.43
Rate for Payer: UnitedHealthcare Community & State	$28.02
Rate for Payer: Wellpoint Medicaid Managed Care	$30.82

STENT URETERAL WIRE 4.7F 22-32

Facility

$319.15

Service Code	HCPCS C2617
Hospital Charge Code	270696691
Hospital Revenue Code	278
Min. Negotiated Rate	$7.69
Max. Negotiated Rate	$159.57
Rate for Payer: Aetna Commercial	$121.28
Rate for Payer: Aetna Medicare Advantage	$95.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.38
Rate for Payer: Cigna Commercial	$159.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$70.21
Rate for Payer: Qualcare PPO/HMO/WC	$47.87
Rate for Payer: UnitedHealthcare Community & State	$7.69
Rate for Payer: Wellpoint Medicaid Managed Care	$8.46

STENT URETERAL WIRE 4.7F 22-32

Facility

$319.15

Service Code	HCPCS C2617
Hospital Charge Code	270696691
Hospital Revenue Code	278
Min. Negotiated Rate	$47.87
Max. Negotiated Rate	$77.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$70.21
Rate for Payer: Qualcare PPO/HMO/WC	$47.87

STENT URETERL SOFT 8.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658595
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 URETERL SOFT 8.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658595N
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 URETERL SOFT 8.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658595
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 URETERL SOFT 8.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658595S
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 URETERL SOFT 8.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658595S
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 URETERL SOFT 8.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658595N
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

Know your out-of-pocket cost for care.

All Charges