Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT URETER PERCUFLEX 6FX24CM

Facility

$1,162.85

Service Code	HCPCS C2617
Hospital Charge Code	270696158
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 URETER PERCUFLEX 6FX24CM

Facility

$1,162.85

Service Code	HCPCS C2617
Hospital Charge Code	270696158
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 URETH 3.0 UROLME 7240201

Facility

$13,020.00

Hospital Charge Code	270932705
Hospital Revenue Code	278
Min. Negotiated Rate	$313.78
Max. Negotiated Rate	$6,510.00
Rate for Payer: Aetna Commercial	$4,947.60
Rate for Payer: Aetna Medicare Advantage	$3,906.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,320.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,320.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,604.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,320.10
Rate for Payer: Cigna Commercial	$6,510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,150.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,864.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,953.00
Rate for Payer: UnitedHealthcare Community & State	$313.78
Rate for Payer: Wellpoint Medicaid Managed Care	$345.03

STENT URETH 3.0 UROLME 7240201

Facility

$10,416.00

Hospital Charge Code	270632705
Hospital Revenue Code	278
Min. Negotiated Rate	$251.03
Max. Negotiated Rate	$5,208.00
Rate for Payer: Aetna Commercial	$3,958.08
Rate for Payer: Aetna Medicare Advantage	$3,124.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,656.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,656.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,083.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,656.08
Rate for Payer: Cigna Commercial	$5,208.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,520.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,291.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,562.40
Rate for Payer: UnitedHealthcare Community & State	$251.03
Rate for Payer: Wellpoint Medicaid Managed Care	$276.02

STENT URETH 3.0 UROLME 7240201

Facility

$10,416.00

Hospital Charge Code	270632705
Hospital Revenue Code	278
Min. Negotiated Rate	$1,562.40
Max. Negotiated Rate	$2,520.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,083.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,520.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,291.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,562.40

STENT URETH 3.0 UROLME 7240201

Facility

$13,020.00

Hospital Charge Code	270932705
Hospital Revenue Code	278
Min. Negotiated Rate	$1,953.00
Max. Negotiated Rate	$3,150.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,604.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,150.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,864.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,953.00

STENT URETHERAL 4.7FR 24CM

Facility

$846.30

Service Code	HCPCS C2625
Hospital Charge Code	270660098
Hospital Revenue Code	278
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$423.15
Rate for Payer: Aetna Commercial	$321.59
Rate for Payer: Aetna Medicare Advantage	$253.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.81
Rate for Payer: Cigna Commercial	$423.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$186.19
Rate for Payer: Qualcare PPO/HMO/WC	$126.94
Rate for Payer: UnitedHealthcare Community & State	$20.40
Rate for Payer: Wellpoint Medicaid Managed Care	$22.43

STENT URETHERAL 4.7FR 24CM

Facility

$846.30

Service Code	HCPCS C2625
Hospital Charge Code	270660098
Hospital Revenue Code	278
Min. Negotiated Rate	$126.94
Max. Negotiated Rate	$204.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$186.19
Rate for Payer: Qualcare PPO/HMO/WC	$126.94

STENT URETHERAL 4.7FR 26CM

Facility

$846.30

Service Code	HCPCS C2625
Hospital Charge Code	270660099
Hospital Revenue Code	278
Min. Negotiated Rate	$126.94
Max. Negotiated Rate	$204.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$186.19
Rate for Payer: Qualcare PPO/HMO/WC	$126.94

STENT URETHERAL 4.7FR 26CM

Facility

$846.30

Service Code	HCPCS C2625
Hospital Charge Code	270660099
Hospital Revenue Code	278
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$423.15
Rate for Payer: Aetna Commercial	$321.59
Rate for Payer: Aetna Medicare Advantage	$253.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.81
Rate for Payer: Cigna Commercial	$423.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$186.19
Rate for Payer: Qualcare PPO/HMO/WC	$126.94
Rate for Payer: UnitedHealthcare Community & State	$20.40
Rate for Payer: Wellpoint Medicaid Managed Care	$22.43

STENTURETPERCUFL6F2.0MMX26CM

Facility

$1,162.85

Service Code	HCPCS C2617
Hospital Charge Code	270696159
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

STENTURETPERCUFL6F2.0MMX26CM

Facility

$1,162.85

Service Code	HCPCS C2617
Hospital Charge Code	270696159
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 URET PGTL 4.7 25 039525

Facility

$920.00

Hospital Charge Code	270601233
Hospital Revenue Code	278
Min. Negotiated Rate	$138.00
Max. Negotiated Rate	$222.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$184.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$222.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$202.40
Rate for Payer: Qualcare PPO/HMO/WC	$138.00

STENT URET PGTL 4.7 25 039525

Facility

$920.00

Hospital Charge Code	270601233
Hospital Revenue Code	278
Min. Negotiated Rate	$22.17
Max. Negotiated Rate	$460.00
Rate for Payer: Aetna Commercial	$349.60
Rate for Payer: Aetna Medicare Advantage	$276.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$234.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$234.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$184.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$234.60
Rate for Payer: Cigna Commercial	$460.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$222.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$202.40
Rate for Payer: Qualcare PPO/HMO/WC	$138.00
Rate for Payer: UnitedHealthcare Community & State	$22.17
Rate for Payer: Wellpoint Medicaid Managed Care	$24.38

STENT URET PGTL 5 24CM 031524

Facility

$436.50

Service Code	HCPCS C2617
Hospital Charge Code	270601228
Hospital Revenue Code	278
Min. Negotiated Rate	$65.47
Max. Negotiated Rate	$105.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$96.03
Rate for Payer: Qualcare PPO/HMO/WC	$65.47

STENT URET PGTL 5 24CM 031524

Facility

$436.50

Service Code	HCPCS C2617
Hospital Charge Code	270601228
Hospital Revenue Code	278
Min. Negotiated Rate	$10.52
Max. Negotiated Rate	$218.25
Rate for Payer: Aetna Commercial	$165.87
Rate for Payer: Aetna Medicare Advantage	$130.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.31
Rate for Payer: Cigna Commercial	$218.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$96.03
Rate for Payer: Qualcare PPO/HMO/WC	$65.47
Rate for Payer: UnitedHealthcare Community & State	$10.52
Rate for Payer: Wellpoint Medicaid Managed Care	$11.57

STENT URET PGTL 5 25CM 031525

Facility

$1,104.85

Hospital Charge Code	270601230
Hospital Revenue Code	278
Min. Negotiated Rate	$165.73
Max. Negotiated Rate	$267.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$220.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$243.07
Rate for Payer: Qualcare PPO/HMO/WC	$165.73

STENT URET PGTL 5 25CM 031525

Facility

$1,104.85

Hospital Charge Code	270601230
Hospital Revenue Code	278
Min. Negotiated Rate	$26.63
Max. Negotiated Rate	$552.42
Rate for Payer: Aetna Commercial	$419.84
Rate for Payer: Aetna Medicare Advantage	$331.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$281.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$281.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$220.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$281.74
Rate for Payer: Cigna Commercial	$552.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$243.07
Rate for Payer: Qualcare PPO/HMO/WC	$165.73
Rate for Payer: UnitedHealthcare Community & State	$26.63
Rate for Payer: Wellpoint Medicaid Managed Care	$29.28

STENT URET PGTL 5 25CM 031525T

Facility

$1,104.85

Hospital Charge Code	270611475
Hospital Revenue Code	272
Min. Negotiated Rate	$26.63
Max. Negotiated Rate	$552.42
Rate for Payer: Aetna Commercial	$419.84
Rate for Payer: Aetna Medicare Advantage	$331.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$281.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$281.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$281.74
Rate for Payer: Cigna Commercial	$552.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$331.45
Rate for Payer: Oxford Commercial	$220.97
Rate for Payer: Qualcare PPO/HMO/WC	$165.73
Rate for Payer: UnitedHealthcare Commercial	$220.97
Rate for Payer: UnitedHealthcare Community & State	$26.63
Rate for Payer: Wellpoint Medicaid Managed Care	$29.28

STENT URET PGTL 5 25CM 031525T

Facility

$1,104.85

Hospital Charge Code	270611475
Hospital Revenue Code	272
Min. Negotiated Rate	$165.73
Max. Negotiated Rate	$165.73
Rate for Payer: Qualcare PPO/HMO/WC	$165.73

STENT URET PGTL 5 27CM 031527

Facility

$920.00

Hospital Charge Code	270601231
Hospital Revenue Code	278
Min. Negotiated Rate	$138.00
Max. Negotiated Rate	$222.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$184.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$222.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$202.40
Rate for Payer: Qualcare PPO/HMO/WC	$138.00

STENT URET PGTL 5 27CM 031527

Facility

$920.00

Hospital Charge Code	270601231
Hospital Revenue Code	278
Min. Negotiated Rate	$22.17
Max. Negotiated Rate	$460.00
Rate for Payer: Aetna Commercial	$349.60
Rate for Payer: Aetna Medicare Advantage	$276.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$234.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$234.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$184.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$234.60
Rate for Payer: Cigna Commercial	$460.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$222.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$202.40
Rate for Payer: Qualcare PPO/HMO/WC	$138.00
Rate for Payer: UnitedHealthcare Community & State	$22.17
Rate for Payer: Wellpoint Medicaid Managed Care	$24.38

STENT URET PGTL 6 22 060022AQ

Facility

$851.25

Hospital Charge Code	270619379
Hospital Revenue Code	278
Min. Negotiated Rate	$20.52
Max. Negotiated Rate	$425.62
Rate for Payer: Aetna Commercial	$323.48
Rate for Payer: Aetna Medicare Advantage	$255.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$217.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$217.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$217.07
Rate for Payer: Cigna Commercial	$425.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$206.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.28
Rate for Payer: Qualcare PPO/HMO/WC	$127.69
Rate for Payer: UnitedHealthcare Community & State	$20.52
Rate for Payer: Wellpoint Medicaid Managed Care	$22.56

STENT URET PGTL 6 22 060022AQ

Facility

$851.25

Hospital Charge Code	270619379
Hospital Revenue Code	278
Min. Negotiated Rate	$127.69
Max. Negotiated Rate	$206.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$206.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.28
Rate for Payer: Qualcare PPO/HMO/WC	$127.69

STENT URET PGTL 6 22 335682

Facility

$775.25

Hospital Charge Code	270615981
Hospital Revenue Code	278
Min. Negotiated Rate	$18.68
Max. Negotiated Rate	$387.62
Rate for Payer: Aetna Commercial	$294.60
Rate for Payer: Aetna Medicare Advantage	$232.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.69
Rate for Payer: Cigna Commercial	$387.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$170.56
Rate for Payer: Qualcare PPO/HMO/WC	$116.29
Rate for Payer: UnitedHealthcare Community & State	$18.68
Rate for Payer: Wellpoint Medicaid Managed Care	$20.54

Know your out-of-pocket cost for care.

All Charges