Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT ADVANTIX PANCRE 10FR 7cm

Facility

$435.00

Hospital Charge Code	270675435
Hospital Revenue Code	278
Min. Negotiated Rate	$10.48
Max. Negotiated Rate	$217.50
Rate for Payer: Aetna Commercial	$165.30
Rate for Payer: Aetna Medicare Advantage	$130.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.92
Rate for Payer: Cigna Commercial	$217.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$95.70
Rate for Payer: Qualcare PPO/HMO/WC	$65.25
Rate for Payer: UnitedHealthcare Community & State	$10.48
Rate for Payer: Wellpoint Medicaid Managed Care	$11.53

STENT ADVANTIX PANCRE 10FR 9cm

Facility

$435.00

Hospital Charge Code	270675436
Hospital Revenue Code	278
Min. Negotiated Rate	$65.25
Max. Negotiated Rate	$105.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$95.70
Rate for Payer: Qualcare PPO/HMO/WC	$65.25

STENT ADVANTIX PANCRE 10FR 9cm

Facility

$435.00

Hospital Charge Code	270675436
Hospital Revenue Code	278
Min. Negotiated Rate	$10.48
Max. Negotiated Rate	$217.50
Rate for Payer: Aetna Commercial	$165.30
Rate for Payer: Aetna Medicare Advantage	$130.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.92
Rate for Payer: Cigna Commercial	$217.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$95.70
Rate for Payer: Qualcare PPO/HMO/WC	$65.25
Rate for Payer: UnitedHealthcare Community & State	$10.48
Rate for Payer: Wellpoint Medicaid Managed Care	$11.53

STENT ANCILLARY COVER

Facility

$35,590.00

Hospital Charge Code	270686467
Hospital Revenue Code	272
Min. Negotiated Rate	$857.72
Max. Negotiated Rate	$17,795.00
Rate for Payer: Aetna Commercial	$13,524.20
Rate for Payer: Aetna Medicare Advantage	$10,677.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,075.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,075.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,075.45
Rate for Payer: Cigna Commercial	$17,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,677.00
Rate for Payer: Oxford Commercial	$7,118.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,338.50
Rate for Payer: UnitedHealthcare Commercial	$7,118.00
Rate for Payer: UnitedHealthcare Community & State	$857.72
Rate for Payer: Wellpoint Medicaid Managed Care	$943.13

STENT ANCILLARY COVER

Facility

$35,590.00

Hospital Charge Code	270686467
Hospital Revenue Code	272
Min. Negotiated Rate	$5,338.50
Max. Negotiated Rate	$5,338.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,338.50

STENT ANTIREFLUX 10x5 FSMAR105

Facility

$1,100.00

Hospital Charge Code	270641702
Hospital Revenue Code	278
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$266.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$220.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$266.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$165.00

STENT ANTIREFLUX 10x5 FSMAR105

Facility

$1,100.00

Hospital Charge Code	270641702
Hospital Revenue Code	278
Min. Negotiated Rate	$26.51
Max. Negotiated Rate	$550.00
Rate for Payer: Aetna Commercial	$418.00
Rate for Payer: Aetna Medicare Advantage	$330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$220.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$280.50
Rate for Payer: Cigna Commercial	$550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$266.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$165.00
Rate for Payer: UnitedHealthcare Community & State	$26.51
Rate for Payer: Wellpoint Medicaid Managed Care	$29.15

STENT ANTIREFLUX 10X7 FSMAR107

Facility

$1,140.00

Hospital Charge Code	270641703
Hospital Revenue Code	278
Min. Negotiated Rate	$27.47
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$27.47
Rate for Payer: Wellpoint Medicaid Managed Care	$30.21

STENT ANTIREFLUX 10X7 FSMAR107

Facility

$1,140.00

Hospital Charge Code	270641703
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

STEN TAX EXP 2.5x16m 389681625

Facility

$13,625.00

Hospital Charge Code	270637307C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,043.75
Max. Negotiated Rate	$3,297.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,997.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.75

STEN TAX EXP 2.5x16m 389681625

Facility

$13,625.00

Hospital Charge Code	270637307C
Hospital Revenue Code	278
Min. Negotiated Rate	$328.36
Max. Negotiated Rate	$6,812.50
Rate for Payer: Aetna Commercial	$5,177.50
Rate for Payer: Aetna Medicare Advantage	$4,087.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,474.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,474.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,474.38
Rate for Payer: Cigna Commercial	$6,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,997.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.75
Rate for Payer: UnitedHealthcare Community & State	$328.36
Rate for Payer: Wellpoint Medicaid Managed Care	$361.06

STEN TAX EXP 3.5x12m 389681235

Facility

$13,625.00

Hospital Charge Code	270637309C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,043.75
Max. Negotiated Rate	$3,297.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,997.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.75

STEN TAX EXP 3.5x12m 389681235

Facility

$13,625.00

Hospital Charge Code	270637309C
Hospital Revenue Code	278
Min. Negotiated Rate	$328.36
Max. Negotiated Rate	$6,812.50
Rate for Payer: Aetna Commercial	$5,177.50
Rate for Payer: Aetna Medicare Advantage	$4,087.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,474.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,474.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,474.38
Rate for Payer: Cigna Commercial	$6,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,997.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.75
Rate for Payer: UnitedHealthcare Community & State	$328.36
Rate for Payer: Wellpoint Medicaid Managed Care	$361.06

STEN TAX EXP 3.5x16m 389681635

Facility

$13,625.00

Hospital Charge Code	270637305C
Hospital Revenue Code	278
Min. Negotiated Rate	$328.36
Max. Negotiated Rate	$6,812.50
Rate for Payer: Aetna Commercial	$5,177.50
Rate for Payer: Aetna Medicare Advantage	$4,087.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,474.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,474.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,474.38
Rate for Payer: Cigna Commercial	$6,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,997.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.75
Rate for Payer: UnitedHealthcare Community & State	$328.36
Rate for Payer: Wellpoint Medicaid Managed Care	$361.06

STEN TAX EXP 3.5x16m 389681635

Facility

$13,625.00

Hospital Charge Code	270637305C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,043.75
Max. Negotiated Rate	$3,297.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,997.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.75

STENT AXIOS SYSTEM 10x10MM

Facility

$24,650.00

Service Code	HCPCS C1874
Hospital Charge Code	270677310
Hospital Revenue Code	278
Min. Negotiated Rate	$3,697.50
Max. Negotiated Rate	$5,965.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,965.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,423.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,697.50

STENT AXIOS SYSTEM 10x10MM

Facility

$24,650.00

Service Code	HCPCS C1874
Hospital Charge Code	270677310
Hospital Revenue Code	278
Min. Negotiated Rate	$594.07
Max. Negotiated Rate	$12,325.00
Rate for Payer: Aetna Commercial	$9,367.00
Rate for Payer: Aetna Medicare Advantage	$7,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,285.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,285.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,930.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,285.75
Rate for Payer: Cigna Commercial	$12,325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,965.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,423.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,697.50
Rate for Payer: UnitedHealthcare Community & State	$594.07
Rate for Payer: Wellpoint Medicaid Managed Care	$653.23

STENT AXIOS SYSTEM 15x10MM

Facility

$22,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270677311
Hospital Revenue Code	278
Min. Negotiated Rate	$3,300.00
Max. Negotiated Rate	$5,324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,324.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,300.00

STENT AXIOS SYSTEM 15x10MM

Facility

$22,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270677311
Hospital Revenue Code	278
Min. Negotiated Rate	$530.20
Max. Negotiated Rate	$11,000.00
Rate for Payer: Aetna Commercial	$8,360.00
Rate for Payer: Aetna Medicare Advantage	$6,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,610.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,610.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,610.00
Rate for Payer: Cigna Commercial	$11,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,324.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,300.00
Rate for Payer: UnitedHealthcare Community & State	$530.20
Rate for Payer: Wellpoint Medicaid Managed Care	$583.00

STENT AXIOS SYSTEM 15 X 15MM

Facility

$24,977.50

Service Code	HCPCS C1874
Hospital Charge Code	270693213
Hospital Revenue Code	278
Min. Negotiated Rate	$3,746.62
Max. Negotiated Rate	$6,044.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,995.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,044.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,495.05
Rate for Payer: Qualcare PPO/HMO/WC	$3,746.62

STENT AXIOS SYSTEM 15 X 15MM

Facility

$24,977.50

Service Code	HCPCS C1874
Hospital Charge Code	270693213
Hospital Revenue Code	278
Min. Negotiated Rate	$601.96
Max. Negotiated Rate	$12,488.75
Rate for Payer: Aetna Commercial	$9,491.45
Rate for Payer: Aetna Medicare Advantage	$7,493.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,369.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,369.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,995.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,369.26
Rate for Payer: Cigna Commercial	$12,488.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,044.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,495.05
Rate for Payer: Qualcare PPO/HMO/WC	$3,746.62
Rate for Payer: UnitedHealthcare Community & State	$601.96
Rate for Payer: Wellpoint Medicaid Managed Care	$661.90

STENT BALLOON AORTIC 65MM

Facility

$3,995.00

Service Code	HCPCS C1725
Hospital Charge Code	270697993C
Hospital Revenue Code	278
Min. Negotiated Rate	$96.28
Max. Negotiated Rate	$1,997.50
Rate for Payer: Aetna Commercial	$1,518.10
Rate for Payer: Aetna Medicare Advantage	$1,198.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,018.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,018.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$799.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,018.73
Rate for Payer: Cigna Commercial	$1,997.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$966.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$878.90
Rate for Payer: Qualcare PPO/HMO/WC	$599.25
Rate for Payer: UnitedHealthcare Community & State	$96.28
Rate for Payer: Wellpoint Medicaid Managed Care	$105.87

STENT BALLOON AORTIC 65MM

Facility

$3,995.00

Service Code	HCPCS C1725
Hospital Charge Code	270697993C
Hospital Revenue Code	278
Min. Negotiated Rate	$599.25
Max. Negotiated Rate	$966.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$799.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$966.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$878.90
Rate for Payer: Qualcare PPO/HMO/WC	$599.25

STENT BILIARY 10-5 SET

Facility

$785.00

Hospital Charge Code	270652849
Hospital Revenue Code	278
Min. Negotiated Rate	$117.75
Max. Negotiated Rate	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$157.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$189.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$172.70
Rate for Payer: Qualcare PPO/HMO/WC	$117.75

STENT BILIARY 10-5 SET

Facility

$785.00

Hospital Charge Code	270652849
Hospital Revenue Code	278
Min. Negotiated Rate	$18.92
Max. Negotiated Rate	$392.50
Rate for Payer: Aetna Commercial	$298.30
Rate for Payer: Aetna Medicare Advantage	$235.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$200.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$200.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$157.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$200.18
Rate for Payer: Cigna Commercial	$392.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$189.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$172.70
Rate for Payer: Qualcare PPO/HMO/WC	$117.75
Rate for Payer: UnitedHealthcare Community & State	$18.92
Rate for Payer: Wellpoint Medicaid Managed Care	$20.80

Know your out-of-pocket cost for care.

All Charges