Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT URET PGTL 6 22 335682

Facility

$775.25

Hospital Charge Code	270615981
Hospital Revenue Code	278
Min. Negotiated Rate	$116.29
Max. Negotiated Rate	$187.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.05
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

STENT URET PGTL 6 22CM 036622

Facility

$670.45

Hospital Charge Code	270618732
Hospital Revenue Code	278
Min. Negotiated Rate	$16.16
Max. Negotiated Rate	$335.23
Rate for Payer: Aetna Commercial	$254.77
Rate for Payer: Aetna Medicare Advantage	$201.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.96
Rate for Payer: Cigna Commercial	$335.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$147.50
Rate for Payer: Qualcare PPO/HMO/WC	$100.57
Rate for Payer: UnitedHealthcare Community & State	$16.16
Rate for Payer: Wellpoint Medicaid Managed Care	$17.77

STENT URET PGTL 6 22CM 036622

Facility

$670.45

Hospital Charge Code	270618732
Hospital Revenue Code	278
Min. Negotiated Rate	$100.57
Max. Negotiated Rate	$162.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$147.50
Rate for Payer: Qualcare PPO/HMO/WC	$100.57

STENT URET PGTL 6 24 060024AQ

Facility

$851.25

Hospital Charge Code	270619391
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 24 060024AQ

Facility

$851.25

Hospital Charge Code	270619391
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 24CM 036624

Facility

$671.25

Hospital Charge Code	270618733
Hospital Revenue Code	278
Min. Negotiated Rate	$100.69
Max. Negotiated Rate	$162.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$147.68
Rate for Payer: Qualcare PPO/HMO/WC	$100.69

STENT URET PGTL 6 24CM 036624

Facility

$671.25

Hospital Charge Code	270618733
Hospital Revenue Code	278
Min. Negotiated Rate	$16.18
Max. Negotiated Rate	$335.62
Rate for Payer: Aetna Commercial	$255.07
Rate for Payer: Aetna Medicare Advantage	$201.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$171.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$171.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$171.17
Rate for Payer: Cigna Commercial	$335.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$147.68
Rate for Payer: Qualcare PPO/HMO/WC	$100.69
Rate for Payer: UnitedHealthcare Community & State	$16.18
Rate for Payer: Wellpoint Medicaid Managed Care	$17.79

STENT URET PGTL 6 26 060026AQ

Facility

$856.00

Hospital Charge Code	270619898
Hospital Revenue Code	278
Min. Negotiated Rate	$128.40
Max. Negotiated Rate	$207.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$188.32
Rate for Payer: Qualcare PPO/HMO/WC	$128.40

STENT URET PGTL 6 26 060026AQ

Facility

$856.00

Hospital Charge Code	270619898
Hospital Revenue Code	278
Min. Negotiated Rate	$20.63
Max. Negotiated Rate	$428.00
Rate for Payer: Aetna Commercial	$325.28
Rate for Payer: Aetna Medicare Advantage	$256.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.28
Rate for Payer: Cigna Commercial	$428.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$188.32
Rate for Payer: Qualcare PPO/HMO/WC	$128.40
Rate for Payer: UnitedHealthcare Community & State	$20.63
Rate for Payer: Wellpoint Medicaid Managed Care	$22.68

STENT URET PGTL 6 26CM 036626

Facility

$668.00

Hospital Charge Code	270618734
Hospital Revenue Code	278
Min. Negotiated Rate	$100.20
Max. Negotiated Rate	$161.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$133.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$161.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$146.96
Rate for Payer: Qualcare PPO/HMO/WC	$100.20

STENT URET PGTL 6 26CM 036626

Facility

$668.00

Hospital Charge Code	270618734
Hospital Revenue Code	278
Min. Negotiated Rate	$16.10
Max. Negotiated Rate	$334.00
Rate for Payer: Aetna Commercial	$253.84
Rate for Payer: Aetna Medicare Advantage	$200.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$133.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.34
Rate for Payer: Cigna Commercial	$334.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$161.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$146.96
Rate for Payer: Qualcare PPO/HMO/WC	$100.20
Rate for Payer: UnitedHealthcare Community & State	$16.10
Rate for Payer: Wellpoint Medicaid Managed Care	$17.70

STENT URET PGTL 7 25CM 031725

Facility

$920.00

Hospital Charge Code	270601229
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 7 25CM 031725

Facility

$920.00

Hospital Charge Code	270601229
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 7 27CM 031727

Facility

$920.00

Hospital Charge Code	270601232
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 7 27CM 031727

Facility

$920.00

Hospital Charge Code	270601232
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 PRCFLX 6X24 175-262

Facility

$1,073.65

Service Code	HCPCS C2617
Hospital Charge Code	270616190
Hospital Revenue Code	278
Min. Negotiated Rate	$161.05
Max. Negotiated Rate	$259.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$259.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.20
Rate for Payer: Qualcare PPO/HMO/WC	$161.05

STENT URET PRCFLX 6X24 175-262

Facility

$1,073.65

Service Code	HCPCS C2617
Hospital Charge Code	270616190
Hospital Revenue Code	278
Min. Negotiated Rate	$25.87
Max. Negotiated Rate	$536.83
Rate for Payer: Aetna Commercial	$407.99
Rate for Payer: Aetna Medicare Advantage	$322.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$273.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$273.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$273.78
Rate for Payer: Cigna Commercial	$536.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$259.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.20
Rate for Payer: Qualcare PPO/HMO/WC	$161.05
Rate for Payer: UnitedHealthcare Community & State	$25.87
Rate for Payer: Wellpoint Medicaid Managed Care	$28.45

STENT URET PRCFLX 7X26 175-273

Facility

$1,073.65

Hospital Charge Code	270616492
Hospital Revenue Code	278
Min. Negotiated Rate	$25.87
Max. Negotiated Rate	$536.83
Rate for Payer: Aetna Commercial	$407.99
Rate for Payer: Aetna Medicare Advantage	$322.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$273.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$273.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$273.78
Rate for Payer: Cigna Commercial	$536.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$259.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.20
Rate for Payer: Qualcare PPO/HMO/WC	$161.05
Rate for Payer: UnitedHealthcare Community & State	$25.87
Rate for Payer: Wellpoint Medicaid Managed Care	$28.45

STENT URET PRCFLX 7X26 175-273

Facility

$1,073.65

Hospital Charge Code	270616492
Hospital Revenue Code	278
Min. Negotiated Rate	$161.05
Max. Negotiated Rate	$259.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$259.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.20
Rate for Payer: Qualcare PPO/HMO/WC	$161.05

STENT VAIBAHN 8MMX5CMX120CM

Facility

$19,320.00

Service Code	HCPCS C1876
Hospital Charge Code	270648642N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,898.00
Max. Negotiated Rate	$4,675.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,864.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,675.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,250.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,898.00

STENT VAIBAHN 8MMX5CMX120CM

Facility

$19,320.00

Service Code	HCPCS C1876
Hospital Charge Code	270648642N
Hospital Revenue Code	278
Min. Negotiated Rate	$465.61
Max. Negotiated Rate	$9,660.00
Rate for Payer: Aetna Commercial	$7,341.60
Rate for Payer: Aetna Medicare Advantage	$5,796.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,926.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,926.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,926.60
Rate for Payer: Cigna Commercial	$9,660.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,675.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,250.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,898.00
Rate for Payer: UnitedHealthcare Community & State	$465.61
Rate for Payer: Wellpoint Medicaid Managed Care	$511.98

STENT VAIBAHN 8MMX5CMX120CM

Facility

$17,615.00

Service Code	HCPCS C1876
Hospital Charge Code	270648642C
Hospital Revenue Code	278
Min. Negotiated Rate	$424.52
Max. Negotiated Rate	$8,807.50
Rate for Payer: Aetna Commercial	$6,693.70
Rate for Payer: Aetna Medicare Advantage	$5,284.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,491.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,491.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,523.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,491.82
Rate for Payer: Cigna Commercial	$8,807.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,262.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,875.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,642.25
Rate for Payer: UnitedHealthcare Community & State	$424.52
Rate for Payer: Wellpoint Medicaid Managed Care	$466.80

STENT VAIBAHN 8MMX5CMX120CM

Facility

$17,615.00

Service Code	HCPCS C1876
Hospital Charge Code	270648642C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,642.25
Max. Negotiated Rate	$4,262.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,523.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,262.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,875.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,642.25

STENT VARIABLE LENGTH 48FR

Facility

$700.00

Service Code	HCPCS C2617
Hospital Charge Code	270650849
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 VARIABLE LENGTH 48FR

Facility

$700.00

Service Code	HCPCS C2617
Hospital Charge Code	270650849
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

Know your out-of-pocket cost for care.

All Charges