Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT ENDOPYELOTOMY RETROMAX

Facility

$990.00

Hospital Charge Code	270655402
Hospital Revenue Code	278
Min. Negotiated Rate	$148.50
Max. Negotiated Rate	$239.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$198.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$239.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$217.80
Rate for Payer: Qualcare PPO/HMO/WC	$148.50

STENT ENDOVASCU G48432

Facility

$42,290.00

Hospital Charge Code	270647928C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,019.19
Max. Negotiated Rate	$21,145.00
Rate for Payer: Aetna Commercial	$16,070.20
Rate for Payer: Aetna Medicare Advantage	$12,687.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,783.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,783.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,458.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,783.95
Rate for Payer: Cigna Commercial	$21,145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,234.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,303.80
Rate for Payer: Qualcare PPO/HMO/WC	$6,343.50
Rate for Payer: UnitedHealthcare Community & State	$1,019.19
Rate for Payer: Wellpoint Medicaid Managed Care	$1,120.68

STENT ENDOVASCU G48432

Facility

$42,290.00

Hospital Charge Code	270647928C
Hospital Revenue Code	278
Min. Negotiated Rate	$6,343.50
Max. Negotiated Rate	$10,234.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,458.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,234.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,303.80
Rate for Payer: Qualcare PPO/HMO/WC	$6,343.50

STENT EPIC VASC 6FR 8x60x75

Facility

$5,375.00

Service Code	HCPCS C1876
Hospital Charge Code	270677594
Hospital Revenue Code	278
Min. Negotiated Rate	$129.54
Max. Negotiated Rate	$2,687.50
Rate for Payer: Aetna Commercial	$2,042.50
Rate for Payer: Aetna Medicare Advantage	$1,612.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,370.62
Rate for Payer: Cigna Commercial	$2,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,182.50
Rate for Payer: Qualcare PPO/HMO/WC	$806.25
Rate for Payer: UnitedHealthcare Community & State	$129.54
Rate for Payer: Wellpoint Medicaid Managed Care	$142.44

STENT EPIC VASC 6FR 8x60x75

Facility

$5,375.00

Service Code	HCPCS C1876
Hospital Charge Code	270677594
Hospital Revenue Code	278
Min. Negotiated Rate	$806.25
Max. Negotiated Rate	$1,300.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,182.50
Rate for Payer: Qualcare PPO/HMO/WC	$806.25

STENT EPIC VASC 6FR 8x60x75

Facility

$6,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270677594N
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

STENT EPIC VASC 6FR 8x60x75

Facility

$6,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270677594N
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

STENT ESOPHAGEAL 23x18x90 1430

Facility

$9,176.00

Hospital Charge Code	270632323
Hospital Revenue Code	278
Min. Negotiated Rate	$221.14
Max. Negotiated Rate	$4,588.00
Rate for Payer: Aetna Commercial	$3,486.88
Rate for Payer: Aetna Medicare Advantage	$2,752.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,339.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,339.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,835.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,339.88
Rate for Payer: Cigna Commercial	$4,588.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,220.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,018.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,376.40
Rate for Payer: UnitedHealthcare Community & State	$221.14
Rate for Payer: Wellpoint Medicaid Managed Care	$243.16

STENT ESOPHAGEAL 23x18x90 1430

Facility

$9,176.00

Hospital Charge Code	270632323
Hospital Revenue Code	278
Min. Negotiated Rate	$1,376.40
Max. Negotiated Rate	$2,220.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,835.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,220.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,018.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,376.40

STENT ESOPHAGEAL POLYFLEX 1430

Facility

$14,337.50

Hospital Charge Code	270637105
Hospital Revenue Code	278
Min. Negotiated Rate	$345.53
Max. Negotiated Rate	$7,168.75
Rate for Payer: Aetna Commercial	$5,448.25
Rate for Payer: Aetna Medicare Advantage	$4,301.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,656.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,656.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,867.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,656.06
Rate for Payer: Cigna Commercial	$7,168.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,469.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,154.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,150.62
Rate for Payer: UnitedHealthcare Community & State	$345.53
Rate for Payer: Wellpoint Medicaid Managed Care	$379.94

STENT ESOPHAGEAL POLYFLEX 1430

Facility

$14,337.50

Hospital Charge Code	270637105
Hospital Revenue Code	278
Min. Negotiated Rate	$2,150.62
Max. Negotiated Rate	$3,469.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,867.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,469.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,154.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,150.62

STENT ESOPHAGEAL POLYFLEX 1431

Facility

$14,337.50

Hospital Charge Code	270637104
Hospital Revenue Code	278
Min. Negotiated Rate	$345.53
Max. Negotiated Rate	$7,168.75
Rate for Payer: Aetna Commercial	$5,448.25
Rate for Payer: Aetna Medicare Advantage	$4,301.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,656.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,656.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,867.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,656.06
Rate for Payer: Cigna Commercial	$7,168.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,469.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,154.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,150.62
Rate for Payer: UnitedHealthcare Community & State	$345.53
Rate for Payer: Wellpoint Medicaid Managed Care	$379.94

STENT ESOPHAGEAL POLYFLEX 1431

Facility

$14,337.50

Hospital Charge Code	270637104
Hospital Revenue Code	278
Min. Negotiated Rate	$2,150.62
Max. Negotiated Rate	$3,469.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,867.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,469.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,154.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,150.62

STENT ESOPHAGEAL WALLFLEX

Facility

$12,500.00

Hospital Charge Code	270659234
Hospital Revenue Code	278
Min. Negotiated Rate	$301.25
Max. Negotiated Rate	$6,250.00
Rate for Payer: Aetna Commercial	$4,750.00
Rate for Payer: Aetna Medicare Advantage	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,187.50
Rate for Payer: Cigna Commercial	$6,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00
Rate for Payer: UnitedHealthcare Community & State	$301.25
Rate for Payer: Wellpoint Medicaid Managed Care	$331.25

STENT ESOPHAGEAL WALLFLEX

Facility

$12,500.00

Hospital Charge Code	270659234
Hospital Revenue Code	278
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$3,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00

STENT ESOPH FULL COVER 19X120

Facility

$14,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270688531
Hospital Revenue Code	272
Min. Negotiated Rate	$337.40
Max. Negotiated Rate	$7,000.00
Rate for Payer: Aetna Commercial	$5,320.00
Rate for Payer: Aetna Medicare Advantage	$4,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,570.00
Rate for Payer: Cigna Commercial	$7,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,200.00
Rate for Payer: Oxford Commercial	$2,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00
Rate for Payer: UnitedHealthcare Commercial	$2,800.00
Rate for Payer: UnitedHealthcare Community & State	$337.40
Rate for Payer: Wellpoint Medicaid Managed Care	$371.00

STENT ESOPH FULL COVER 19X120

Facility

$14,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270688531
Hospital Revenue Code	272
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$2,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00

STENT EVERFLEX 5MMx80MM 120CM

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270640103S
Hospital Revenue Code	278
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

STENT EVERFLEX 5MMx80MM 120CM

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270640103N
Hospital Revenue Code	278
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

STENT EVERFLEX 5MMx80MM 120CM

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270640103
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT EVERFLEX 5MMx80MM 120CM

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270640103
Hospital Revenue Code	278
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

STENT EVERFLEX 5MMx80MM 120CM

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270640103N
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT EVERFLEX 5MMx80MM 120CM

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270640103S
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT EVERFLEX 6/100/120

Facility

$7,975.00

Hospital Charge Code	2709002179
Hospital Revenue Code	272
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) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,392.50
Rate for Payer: Oxford Commercial	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25
Rate for Payer: UnitedHealthcare Commercial	$1,595.00
Rate for Payer: UnitedHealthcare Community & State	$192.20
Rate for Payer: Wellpoint Medicaid Managed Care	$211.34

STENT EVERFLEX 6/100/120

Facility

$7,975.00

Hospital Charge Code	2709002179
Hospital Revenue Code	272
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,196.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

Know your out-of-pocket cost for care.

All Charges