Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT XIENCE 4.0X23MM

Facility

$16,294.37

Hospital Charge Code	270640950C
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 4.0X23MM

Facility

$16,294.37

Hospital Charge Code	270640950C
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 4.0x28 100954328

Facility

$16,294.37

Hospital Charge Code	270643951V
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 4.0x28 100954328

Facility

$16,294.37

Hospital Charge Code	270643951V
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 4.0x28 100954328

Facility

$16,294.37

Hospital Charge Code	270640951C
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 4.0x28 100954328

Facility

$16,294.37

Hospital Charge Code	270640951C
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 4.0x28 100954328

Facility

$16,294.37

Hospital Charge Code	270640951V
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 4.0x28 100954328

Facility

$16,294.37

Hospital Charge Code	270640951V
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 4.0x38 10011735

Facility

$16,294.37

Hospital Charge Code	270647340C
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 4.0x38 10011735

Facility

$16,294.37

Hospital Charge Code	270647340C
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 4.0X8MM

Facility

$16,294.37

Hospital Charge Code	270640946C
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 4.0X8MM

Facility

$16,294.37

Hospital Charge Code	270640946C
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 ALPINE 2.25x12MM

Facility

$5,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270675995
Hospital Revenue Code	278
Min. Negotiated Rate	$126.53
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$126.53
Rate for Payer: Wellpoint Medicaid Managed Care	$139.12

STENT XIENCE ALPINE 2.25x12MM

Facility

$5,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270675995
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

STENT XIENCE ALPINE 2.25x15MM

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270675996
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT XIENCE ALPINE 2.25x15MM

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270675996
Hospital Revenue Code	278
Min. Negotiated Rate	$168.70
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,660.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$168.70
Rate for Payer: Wellpoint Medicaid Managed Care	$185.50

STENT XIENCE ALPINE 2.25x18MM

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270675997
Hospital Revenue Code	278
Min. Negotiated Rate	$168.70
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,660.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$168.70
Rate for Payer: Wellpoint Medicaid Managed Care	$185.50

STENT XIENCE ALPINE 2.25x18MM

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270675997
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT XIENCE ALPINE 2.25x23MM

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270675998
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT XIENCE ALPINE 2.25x23MM

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270675998
Hospital Revenue Code	278
Min. Negotiated Rate	$168.70
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,660.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$168.70
Rate for Payer: Wellpoint Medicaid Managed Care	$185.50

STENT XIENCE ALPINE 2.25x28MM

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270675999
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT XIENCE ALPINE 2.25x28MM

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270675999
Hospital Revenue Code	278
Min. Negotiated Rate	$168.70
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,660.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$168.70
Rate for Payer: Wellpoint Medicaid Managed Care	$185.50

STENT XIENCE ALPINE 2.25x8MM

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270675994
Hospital Revenue Code	278
Min. Negotiated Rate	$168.70
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,660.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$168.70
Rate for Payer: Wellpoint Medicaid Managed Care	$185.50

STENT XIENCE ALPINE 2.25x8MM

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270675994
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT XIENCE ALPINE 2.5x12MM

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270676001
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

Know your out-of-pocket cost for care.

All Charges