Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT XIENCE PRIME 3.0MMX38MM

Facility

$16,294.37

Hospital Charge Code	270647334C
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 PRIME 3.0MMX38MM

Facility

$16,294.37

Hospital Charge Code	270647334C
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 PRIME 3.0x28mm

Facility

$7,975.00

Hospital Charge Code	270647332
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,929.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

STENT XIENCE PRIME 3.0x28mm

Facility

$7,975.00

Hospital Charge Code	270647332
Hospital Revenue Code	278
Min. Negotiated Rate	$192.20
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$3,030.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25
Rate for Payer: UnitedHealthcare Community & State	$192.20
Rate for Payer: Wellpoint Medicaid Managed Care	$211.34

STENT XIENCE PRIME 3.5MMX38MM

Facility

$16,294.37

Hospital Charge Code	270647337C
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 PRIME 3.5MMX38MM

Facility

$16,294.37

Hospital Charge Code	270647337C
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 PRIME 4.0MMX33MM

Facility

$16,294.37

Hospital Charge Code	270647339C
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 PRIME 4.0MMX33MM

Facility

$16,294.37

Hospital Charge Code	270647339C
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 PRIME 4.0X28MM

Facility

$7,975.00

Hospital Charge Code	270647338
Hospital Revenue Code	278
Min. Negotiated Rate	$192.20
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$3,030.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25
Rate for Payer: UnitedHealthcare Community & State	$192.20
Rate for Payer: Wellpoint Medicaid Managed Care	$211.34

STENT XIENCE PRIME 4.0X28MM

Facility

$7,975.00

Hospital Charge Code	270647338
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,929.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

STENT XIENCE PRIME 4.0x38mm

Facility

$9,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270647340
Hospital Revenue Code	278
Min. Negotiated Rate	$222.93
Max. Negotiated Rate	$4,625.00
Rate for Payer: Aetna Commercial	$3,515.00
Rate for Payer: Aetna Medicare Advantage	$2,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,358.75
Rate for Payer: Cigna Commercial	$4,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,035.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50
Rate for Payer: UnitedHealthcare Community & State	$222.93
Rate for Payer: Wellpoint Medicaid Managed Care	$245.12

STENT XIENCE PRIME 4.0x38mm

Facility

$9,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270647340
Hospital Revenue Code	278
Min. Negotiated Rate	$1,387.50
Max. Negotiated Rate	$2,238.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,035.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50

STENT XIENCE PRIMER 3.5x28mm

Facility

$7,975.00

Hospital Charge Code	270647335
Hospital Revenue Code	278
Min. Negotiated Rate	$192.20
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$3,030.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25
Rate for Payer: UnitedHealthcare Community & State	$192.20
Rate for Payer: Wellpoint Medicaid Managed Care	$211.34

STENT XIENCE PRIMER 3.5x28mm

Facility

$7,975.00

Hospital Charge Code	270647335
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,929.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

STENT XIENCE SKY P 2.25 X 08

Facility

$3,500.00

Service Code	HCPCS C1875
Hospital Charge Code	270704350
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

STENT XIENCE SKY P 2.25 X 08

Facility

$3,500.00

Hospital Charge Code	270704353
Hospital Revenue Code	272
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.00
Rate for Payer: Oxford Commercial	$700.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Commercial	$700.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

STENT XIENCE SKY P 2.25 X 08

Facility

$3,500.00

Hospital Charge Code	270704353
Hospital Revenue Code	272
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

STENT XIENCE SKY P 2.25 X 08

Facility

$3,500.00

Service Code	HCPCS C1875
Hospital Charge Code	270704350
Hospital Revenue Code	278
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

STENT XIENCE SKY P 2.25 X 12 R

Facility

$3,500.00

Service Code	HCPCS C1875
Hospital Charge Code	270704351
Hospital Revenue Code	278
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

STENT XIENCE SKY P 2.25 X 12 R

Facility

$3,500.00

Service Code	HCPCS C1875
Hospital Charge Code	270704351
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

STENT XIENCE SKY P 2.25 X 15

Facility

$3,500.00

Service Code	HCPCS C1875
Hospital Charge Code	270704352
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

STENT XIENCE SKY P 2.25 X 15

Facility

$3,500.00

Service Code	HCPCS C1875
Hospital Charge Code	270704352
Hospital Revenue Code	278
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

STENT XIENCE SKY P 2.25 X 23

Facility

$3,500.00

Hospital Charge Code	270704354
Hospital Revenue Code	272
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.00
Rate for Payer: Oxford Commercial	$700.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Commercial	$700.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

STENT XIENCE SKY P 2.25 X 23

Facility

$3,500.00

Hospital Charge Code	270704354
Hospital Revenue Code	272
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

STENT XIENCE SKY P 2.25 X 28

Facility

$3,500.00

Hospital Charge Code	270704355
Hospital Revenue Code	272
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

Know your out-of-pocket cost for care.

All Charges