Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STAPLE RELOAD TI TRI 2.0 45MM

Facility

$3,265.83

Service Code	HCPCS C1713
Hospital Charge Code	270691808
Hospital Revenue Code	272
Min. Negotiated Rate	$78.71
Max. Negotiated Rate	$1,632.91
Rate for Payer: Aetna Commercial	$1,241.02
Rate for Payer: Aetna Medicare Advantage	$979.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$832.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$832.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$832.79
Rate for Payer: Cigna Commercial	$1,632.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$979.75
Rate for Payer: Oxford Commercial	$653.17
Rate for Payer: Qualcare PPO/HMO/WC	$489.87
Rate for Payer: UnitedHealthcare Commercial	$653.17
Rate for Payer: UnitedHealthcare Community & State	$78.71
Rate for Payer: Wellpoint Medicaid Managed Care	$86.54

STAPLE RELOAD TI TRI 2.0 45MM

Facility

$3,265.83

Service Code	HCPCS C1713
Hospital Charge Code	270691808
Hospital Revenue Code	272
Min. Negotiated Rate	$489.87
Max. Negotiated Rate	$489.87
Rate for Payer: Qualcare PPO/HMO/WC	$489.87

STAPLER ENDO GIA 30 2.5 030811

Facility

$1,508.00

Hospital Charge Code	270600118
Hospital Revenue Code	272
Min. Negotiated Rate	$36.34
Max. Negotiated Rate	$754.00
Rate for Payer: Aetna Commercial	$573.04
Rate for Payer: Aetna Medicare Advantage	$452.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$384.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$384.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$384.54
Rate for Payer: Cigna Commercial	$754.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$452.40
Rate for Payer: Oxford Commercial	$301.60
Rate for Payer: Qualcare PPO/HMO/WC	$226.20
Rate for Payer: UnitedHealthcare Commercial	$301.60
Rate for Payer: UnitedHealthcare Community & State	$36.34
Rate for Payer: Wellpoint Medicaid Managed Care	$39.96

STAPLER ENDO GIA 30 2.5 030811

Facility

$1,508.00

Hospital Charge Code	270600118
Hospital Revenue Code	272
Min. Negotiated Rate	$226.20
Max. Negotiated Rate	$226.20
Rate for Payer: Qualcare PPO/HMO/WC	$226.20

STAPLER ENDO GIA 30 3.5 030813

Facility

$1,508.00

Hospital Charge Code	270600120
Hospital Revenue Code	272
Min. Negotiated Rate	$226.20
Max. Negotiated Rate	$226.20
Rate for Payer: Qualcare PPO/HMO/WC	$226.20

STAPLER ENDO GIA 30 3.5 030813

Facility

$1,508.00

Hospital Charge Code	270600120
Hospital Revenue Code	272
Min. Negotiated Rate	$36.34
Max. Negotiated Rate	$754.00
Rate for Payer: Aetna Commercial	$573.04
Rate for Payer: Aetna Medicare Advantage	$452.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$384.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$384.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$384.54
Rate for Payer: Cigna Commercial	$754.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$452.40
Rate for Payer: Oxford Commercial	$301.60
Rate for Payer: Qualcare PPO/HMO/WC	$226.20
Rate for Payer: UnitedHealthcare Commercial	$301.60
Rate for Payer: UnitedHealthcare Community & State	$36.34
Rate for Payer: Wellpoint Medicaid Managed Care	$39.96

STAPLER ENDO GIA 30-3.5 BLUE

Facility

$683.60

Hospital Charge Code	270675452
Hospital Revenue Code	272
Min. Negotiated Rate	$102.54
Max. Negotiated Rate	$102.54
Rate for Payer: Qualcare PPO/HMO/WC	$102.54

STAPLER ENDO GIA 30-3.5 BLUE

Facility

$683.60

Hospital Charge Code	270675452
Hospital Revenue Code	272
Min. Negotiated Rate	$16.47
Max. Negotiated Rate	$341.80
Rate for Payer: Aetna Commercial	$259.77
Rate for Payer: Aetna Medicare Advantage	$205.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$174.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$174.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$174.32
Rate for Payer: Cigna Commercial	$341.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.08
Rate for Payer: Oxford Commercial	$136.72
Rate for Payer: Qualcare PPO/HMO/WC	$102.54
Rate for Payer: UnitedHealthcare Commercial	$136.72
Rate for Payer: UnitedHealthcare Community & State	$16.47
Rate for Payer: Wellpoint Medicaid Managed Care	$18.12

STAPLER ENDO GIA 45MM SRTI MED

Facility

$855.58

Hospital Charge Code	270675746
Hospital Revenue Code	272
Min. Negotiated Rate	$20.62
Max. Negotiated Rate	$427.79
Rate for Payer: Aetna Commercial	$325.12
Rate for Payer: Aetna Medicare Advantage	$256.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.17
Rate for Payer: Cigna Commercial	$427.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$256.67
Rate for Payer: Oxford Commercial	$171.12
Rate for Payer: Qualcare PPO/HMO/WC	$128.34
Rate for Payer: UnitedHealthcare Commercial	$171.12
Rate for Payer: UnitedHealthcare Community & State	$20.62
Rate for Payer: Wellpoint Medicaid Managed Care	$22.67

STAPLER ENDO GIA 45MM SRTI MED

Facility

$855.58

Hospital Charge Code	270675746
Hospital Revenue Code	272
Min. Negotiated Rate	$128.34
Max. Negotiated Rate	$128.34
Rate for Payer: Qualcare PPO/HMO/WC	$128.34

STAPLER ENDO GIA 60 2.5 030304

Facility

$2,202.45

Hospital Charge Code	270600124
Hospital Revenue Code	272
Min. Negotiated Rate	$330.37
Max. Negotiated Rate	$330.37
Rate for Payer: Qualcare PPO/HMO/WC	$330.37

STAPLER ENDO GIA 60 2.5 030304

Facility

$2,202.45

Hospital Charge Code	270600124
Hospital Revenue Code	272
Min. Negotiated Rate	$53.08
Max. Negotiated Rate	$1,101.22
Rate for Payer: Aetna Commercial	$836.93
Rate for Payer: Aetna Medicare Advantage	$660.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$561.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$561.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$561.62
Rate for Payer: Cigna Commercial	$1,101.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$660.74
Rate for Payer: Oxford Commercial	$440.49
Rate for Payer: Qualcare PPO/HMO/WC	$330.37
Rate for Payer: UnitedHealthcare Commercial	$440.49
Rate for Payer: UnitedHealthcare Community & State	$53.08
Rate for Payer: Wellpoint Medicaid Managed Care	$58.36

STAPLER ENDO GIA 60 3.5 030302

Facility

$2,557.65

Hospital Charge Code	270600122
Hospital Revenue Code	272
Min. Negotiated Rate	$61.64
Max. Negotiated Rate	$1,278.83
Rate for Payer: Aetna Commercial	$971.91
Rate for Payer: Aetna Medicare Advantage	$767.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$652.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$652.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$652.20
Rate for Payer: Cigna Commercial	$1,278.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$767.29
Rate for Payer: Oxford Commercial	$511.53
Rate for Payer: Qualcare PPO/HMO/WC	$383.65
Rate for Payer: UnitedHealthcare Commercial	$511.53
Rate for Payer: UnitedHealthcare Community & State	$61.64
Rate for Payer: Wellpoint Medicaid Managed Care	$67.78

STAPLER ENDO GIA 60 3.5 030302

Facility

$2,557.65

Hospital Charge Code	270600122
Hospital Revenue Code	272
Min. Negotiated Rate	$383.65
Max. Negotiated Rate	$383.65
Rate for Payer: Qualcare PPO/HMO/WC	$383.65

STAPLER ENDO GIA 60 4.8 030306

Facility

$2,684.85

Hospital Charge Code	270600106
Hospital Revenue Code	272
Min. Negotiated Rate	$64.70
Max. Negotiated Rate	$1,342.42
Rate for Payer: Aetna Commercial	$1,020.24
Rate for Payer: Aetna Medicare Advantage	$805.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$684.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$684.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$684.64
Rate for Payer: Cigna Commercial	$1,342.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$805.46
Rate for Payer: Oxford Commercial	$536.97
Rate for Payer: Qualcare PPO/HMO/WC	$402.73
Rate for Payer: UnitedHealthcare Commercial	$536.97
Rate for Payer: UnitedHealthcare Community & State	$64.70
Rate for Payer: Wellpoint Medicaid Managed Care	$71.15

STAPLER ENDO GIA 60 4.8 030306

Facility

$2,684.85

Hospital Charge Code	270600106
Hospital Revenue Code	272
Min. Negotiated Rate	$402.73
Max. Negotiated Rate	$402.73
Rate for Payer: Qualcare PPO/HMO/WC	$402.73

STAPLER ENDO GIA 60MM ARTI MED

Facility

$2,530.99

Hospital Charge Code	270652107
Hospital Revenue Code	272
Min. Negotiated Rate	$379.65
Max. Negotiated Rate	$379.65
Rate for Payer: Qualcare PPO/HMO/WC	$379.65

STAPLER ENDO GIA 60MM ARTI MED

Facility

$2,530.99

Hospital Charge Code	270652107
Hospital Revenue Code	272
Min. Negotiated Rate	$61.00
Max. Negotiated Rate	$1,265.49
Rate for Payer: Aetna Commercial	$961.78
Rate for Payer: Aetna Medicare Advantage	$759.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$645.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$645.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$645.40
Rate for Payer: Cigna Commercial	$1,265.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$759.30
Rate for Payer: Oxford Commercial	$506.20
Rate for Payer: Qualcare PPO/HMO/WC	$379.65
Rate for Payer: UnitedHealthcare Commercial	$506.20
Rate for Payer: UnitedHealthcare Community & State	$61.00
Rate for Payer: Wellpoint Medicaid Managed Care	$67.07

STAPLER ENDO GIA 60MM ARTI VAS

Facility

$1,119.05

Hospital Charge Code	270655978
Hospital Revenue Code	272
Min. Negotiated Rate	$167.86
Max. Negotiated Rate	$167.86
Rate for Payer: Qualcare PPO/HMO/WC	$167.86

STAPLER ENDO GIA 60MM ARTI VAS

Facility

$1,119.05

Hospital Charge Code	270655978
Hospital Revenue Code	272
Min. Negotiated Rate	$26.97
Max. Negotiated Rate	$559.52
Rate for Payer: Aetna Commercial	$425.24
Rate for Payer: Aetna Medicare Advantage	$335.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$285.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$285.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$285.36
Rate for Payer: Cigna Commercial	$559.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$335.71
Rate for Payer: Oxford Commercial	$223.81
Rate for Payer: Qualcare PPO/HMO/WC	$167.86
Rate for Payer: UnitedHealthcare Commercial	$223.81
Rate for Payer: UnitedHealthcare Community & State	$26.97
Rate for Payer: Wellpoint Medicaid Managed Care	$29.65

STAPLER ENDO GIA ARTI MED 45MM

Facility

$2,187.03

Service Code	HCPCS C1713
Hospital Charge Code	270665644
Hospital Revenue Code	278
Min. Negotiated Rate	$52.71
Max. Negotiated Rate	$1,093.52
Rate for Payer: Aetna Commercial	$831.07
Rate for Payer: Aetna Medicare Advantage	$656.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$557.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$557.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$437.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$557.69
Rate for Payer: Cigna Commercial	$1,093.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$529.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$481.15
Rate for Payer: Qualcare PPO/HMO/WC	$328.05
Rate for Payer: UnitedHealthcare Community & State	$52.71
Rate for Payer: Wellpoint Medicaid Managed Care	$57.96

STAPLER ENDO GIA ARTI MED 45MM

Facility

$2,187.03

Service Code	HCPCS C1713
Hospital Charge Code	270665644
Hospital Revenue Code	278
Min. Negotiated Rate	$328.05
Max. Negotiated Rate	$529.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$437.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$529.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$481.15
Rate for Payer: Qualcare PPO/HMO/WC	$328.05

STAPLER ENDO GIA STANDARD

Facility

$529.50

Hospital Charge Code	270691962
Hospital Revenue Code	272
Min. Negotiated Rate	$79.42
Max. Negotiated Rate	$79.42
Rate for Payer: Qualcare PPO/HMO/WC	$79.42

STAPLER ENDO GIA STANDARD

Facility

$529.50

Hospital Charge Code	270691962
Hospital Revenue Code	272
Min. Negotiated Rate	$12.76
Max. Negotiated Rate	$264.75
Rate for Payer: Aetna Commercial	$201.21
Rate for Payer: Aetna Medicare Advantage	$158.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$135.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$135.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$135.02
Rate for Payer: Cigna Commercial	$264.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.85
Rate for Payer: Oxford Commercial	$105.90
Rate for Payer: Qualcare PPO/HMO/WC	$79.42
Rate for Payer: UnitedHealthcare Commercial	$105.90
Rate for Payer: UnitedHealthcare Community & State	$12.76
Rate for Payer: Wellpoint Medicaid Managed Care	$14.03

STAPLER ENDOPATH ECHELON FX 60

Facility

$859.17

Hospital Charge Code	270669515
Hospital Revenue Code	272
Min. Negotiated Rate	$128.88
Max. Negotiated Rate	$128.88
Rate for Payer: Qualcare PPO/HMO/WC	$128.88

Know your out-of-pocket cost for care.

All Charges