Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT XACT CAROTID 10-8 30MM

Facility

$10,250.00

Hospital Charge Code	270644100C
Hospital Revenue Code	278
Min. Negotiated Rate	$247.03
Max. Negotiated Rate	$5,125.00
Rate for Payer: Aetna Commercial	$3,895.00
Rate for Payer: Aetna Medicare Advantage	$3,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,613.75
Rate for Payer: Cigna Commercial	$5,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,255.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50
Rate for Payer: UnitedHealthcare Community & State	$247.03
Rate for Payer: Wellpoint Medicaid Managed Care	$271.62

STENT XACT CAROTID 7X30MM

Facility

$10,250.00

Hospital Charge Code	270643951C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$2,480.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,255.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

STENT XACT CAROTID 7X30MM

Facility

$10,250.00

Hospital Charge Code	270643951C
Hospital Revenue Code	278
Min. Negotiated Rate	$247.03
Max. Negotiated Rate	$5,125.00
Rate for Payer: Aetna Commercial	$3,895.00
Rate for Payer: Aetna Medicare Advantage	$3,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,613.75
Rate for Payer: Cigna Commercial	$5,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,255.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50
Rate for Payer: UnitedHealthcare Community & State	$247.03
Rate for Payer: Wellpoint Medicaid Managed Care	$271.62

STENT XACT CAROTID 8-6 30MM

Facility

$10,250.00

Hospital Charge Code	270644097C
Hospital Revenue Code	278
Min. Negotiated Rate	$247.03
Max. Negotiated Rate	$5,125.00
Rate for Payer: Aetna Commercial	$3,895.00
Rate for Payer: Aetna Medicare Advantage	$3,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,613.75
Rate for Payer: Cigna Commercial	$5,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,255.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50
Rate for Payer: UnitedHealthcare Community & State	$247.03
Rate for Payer: Wellpoint Medicaid Managed Care	$271.62

STENT XACT CAROTID 8-6 30MM

Facility

$10,250.00

Hospital Charge Code	270644097C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$2,480.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,255.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

STENT XACT CAROTID 8-6 40MM

Facility

$10,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270644098C
Hospital Revenue Code	278
Min. Negotiated Rate	$247.03
Max. Negotiated Rate	$5,125.00
Rate for Payer: Aetna Commercial	$3,895.00
Rate for Payer: Aetna Medicare Advantage	$3,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,613.75
Rate for Payer: Cigna Commercial	$5,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,255.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50
Rate for Payer: UnitedHealthcare Community & State	$247.03
Rate for Payer: Wellpoint Medicaid Managed Care	$271.62

STENT XACT CAROTID 8-6 40MM

Facility

$10,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270644098C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$2,480.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,255.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

STENT XACT CAROTID 9-7 30MM

Facility

$10,250.00

Hospital Charge Code	270643746C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$2,480.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,255.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

STENT XACT CAROTID 9-7 30MM

Facility

$10,250.00

Hospital Charge Code	270643746C
Hospital Revenue Code	278
Min. Negotiated Rate	$247.03
Max. Negotiated Rate	$5,125.00
Rate for Payer: Aetna Commercial	$3,895.00
Rate for Payer: Aetna Medicare Advantage	$3,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,613.75
Rate for Payer: Cigna Commercial	$5,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,255.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50
Rate for Payer: UnitedHealthcare Community & State	$247.03
Rate for Payer: Wellpoint Medicaid Managed Care	$271.62

STENT XACT CAROTID 9-7 40MM

Facility

$10,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270644099C
Hospital Revenue Code	278
Min. Negotiated Rate	$247.03
Max. Negotiated Rate	$5,125.00
Rate for Payer: Aetna Commercial	$3,895.00
Rate for Payer: Aetna Medicare Advantage	$3,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,613.75
Rate for Payer: Cigna Commercial	$5,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,255.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50
Rate for Payer: UnitedHealthcare Community & State	$247.03
Rate for Payer: Wellpoint Medicaid Managed Care	$271.62

STENT XACT CAROTID 9-7 40MM

Facility

$10,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270644099C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$2,480.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,255.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

STENT XCEED 7x120mm 1486405

Facility

$5,952.00

Hospital Charge Code	270635336V
Hospital Revenue Code	278
Min. Negotiated Rate	$143.44
Max. Negotiated Rate	$2,976.00
Rate for Payer: Aetna Commercial	$2,261.76
Rate for Payer: Aetna Medicare Advantage	$1,785.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,517.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,517.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,190.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,517.76
Rate for Payer: Cigna Commercial	$2,976.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,440.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,309.44
Rate for Payer: Qualcare PPO/HMO/WC	$892.80
Rate for Payer: UnitedHealthcare Community & State	$143.44
Rate for Payer: Wellpoint Medicaid Managed Care	$157.73

STENT XCEED 7x120mm 1486405

Facility

$5,952.00

Hospital Charge Code	270635336
Hospital Revenue Code	278
Min. Negotiated Rate	$892.80
Max. Negotiated Rate	$1,440.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,190.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,440.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,309.44
Rate for Payer: Qualcare PPO/HMO/WC	$892.80

STENT XCEED 7x120mm 1486405

Facility

$5,952.00

Hospital Charge Code	270635336
Hospital Revenue Code	278
Min. Negotiated Rate	$143.44
Max. Negotiated Rate	$2,976.00
Rate for Payer: Aetna Commercial	$2,261.76
Rate for Payer: Aetna Medicare Advantage	$1,785.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,517.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,517.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,190.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,517.76
Rate for Payer: Cigna Commercial	$2,976.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,440.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,309.44
Rate for Payer: Qualcare PPO/HMO/WC	$892.80
Rate for Payer: UnitedHealthcare Community & State	$143.44
Rate for Payer: Wellpoint Medicaid Managed Care	$157.73

STENT XCEED 7x120mm 1486405

Facility

$5,952.00

Hospital Charge Code	270635336V
Hospital Revenue Code	278
Min. Negotiated Rate	$892.80
Max. Negotiated Rate	$1,440.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,190.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,440.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,309.44
Rate for Payer: Qualcare PPO/HMO/WC	$892.80

STENT XCEED 8x40 80cm 1487001

Facility

$5,952.00

Hospital Charge Code	270634996
Hospital Revenue Code	278
Min. Negotiated Rate	$143.44
Max. Negotiated Rate	$2,976.00
Rate for Payer: Aetna Commercial	$2,261.76
Rate for Payer: Aetna Medicare Advantage	$1,785.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,517.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,517.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,190.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,517.76
Rate for Payer: Cigna Commercial	$2,976.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,440.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,309.44
Rate for Payer: Qualcare PPO/HMO/WC	$892.80
Rate for Payer: UnitedHealthcare Community & State	$143.44
Rate for Payer: Wellpoint Medicaid Managed Care	$157.73

STENT XCEED 8x40 80cm 1487001

Facility

$5,952.00

Hospital Charge Code	270634996V
Hospital Revenue Code	278
Min. Negotiated Rate	$892.80
Max. Negotiated Rate	$1,440.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,190.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,440.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,309.44
Rate for Payer: Qualcare PPO/HMO/WC	$892.80

STENT XCEED 8x40 80cm 1487001

Facility

$5,952.00

Hospital Charge Code	270634996V
Hospital Revenue Code	278
Min. Negotiated Rate	$143.44
Max. Negotiated Rate	$2,976.00
Rate for Payer: Aetna Commercial	$2,261.76
Rate for Payer: Aetna Medicare Advantage	$1,785.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,517.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,517.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,190.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,517.76
Rate for Payer: Cigna Commercial	$2,976.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,440.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,309.44
Rate for Payer: Qualcare PPO/HMO/WC	$892.80
Rate for Payer: UnitedHealthcare Community & State	$143.44
Rate for Payer: Wellpoint Medicaid Managed Care	$157.73

STENT XCEED 8x40 80cm 1487001

Facility

$5,952.00

Hospital Charge Code	270634996
Hospital Revenue Code	278
Min. Negotiated Rate	$892.80
Max. Negotiated Rate	$1,440.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,190.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,440.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,309.44
Rate for Payer: Qualcare PPO/HMO/WC	$892.80

STENT XIENCE 2.5X12M 100953912

Facility

$16,294.37

Hospital Charge Code	270640905C
Hospital Revenue Code	278
Min. Negotiated Rate	$392.69
Max. Negotiated Rate	$8,147.19
Rate for Payer: Aetna Commercial	$6,191.86
Rate for Payer: Aetna Medicare Advantage	$4,888.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,155.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,155.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,258.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,155.06
Rate for Payer: Cigna Commercial	$8,147.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,943.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,584.76
Rate for Payer: Qualcare PPO/HMO/WC	$2,444.16
Rate for Payer: UnitedHealthcare Community & State	$392.69
Rate for Payer: Wellpoint Medicaid Managed Care	$431.80

STENT XIENCE 2.5X12M 100953912

Facility

$16,294.37

Hospital Charge Code	270640905C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,444.16
Max. Negotiated Rate	$3,943.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,258.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,943.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,584.76
Rate for Payer: Qualcare PPO/HMO/WC	$2,444.16

STENT XIENCE 2.5X15MM 10095395

Facility

$16,294.37

Hospital Charge Code	270640906C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,444.16
Max. Negotiated Rate	$3,943.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,258.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,943.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,584.76
Rate for Payer: Qualcare PPO/HMO/WC	$2,444.16

STENT XIENCE 2.5X15MM 10095395

Facility

$16,294.37

Hospital Charge Code	270640906C
Hospital Revenue Code	278
Min. Negotiated Rate	$392.69
Max. Negotiated Rate	$8,147.19
Rate for Payer: Aetna Commercial	$6,191.86
Rate for Payer: Aetna Medicare Advantage	$4,888.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,155.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,155.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,258.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,155.06
Rate for Payer: Cigna Commercial	$8,147.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,943.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,584.76
Rate for Payer: Qualcare PPO/HMO/WC	$2,444.16
Rate for Payer: UnitedHealthcare Community & State	$392.69
Rate for Payer: Wellpoint Medicaid Managed Care	$431.80

STENT XIENCE 2.5X18MM

Facility

$16,294.37

Hospital Charge Code	270640907C
Hospital Revenue Code	278
Min. Negotiated Rate	$392.69
Max. Negotiated Rate	$8,147.19
Rate for Payer: Aetna Commercial	$6,191.86
Rate for Payer: Aetna Medicare Advantage	$4,888.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,155.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,155.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,258.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,155.06
Rate for Payer: Cigna Commercial	$8,147.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,943.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,584.76
Rate for Payer: Qualcare PPO/HMO/WC	$2,444.16
Rate for Payer: UnitedHealthcare Community & State	$392.69
Rate for Payer: Wellpoint Medicaid Managed Care	$431.80

STENT XIENCE 2.5X18MM

Facility

$16,294.37

Hospital Charge Code	270640907C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,444.16
Max. Negotiated Rate	$3,943.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,258.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,943.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,584.76
Rate for Payer: Qualcare PPO/HMO/WC	$2,444.16

Know your out-of-pocket cost for care.

All Charges