Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT GRAFT 10FR 11MM X 10CM

Facility

$20,450.00

Service Code	HCPCS C1874
Hospital Charge Code	270692118
Hospital Revenue Code	278
Min. Negotiated Rate	$3,067.50
Max. Negotiated Rate	$4,948.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,090.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,948.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,499.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,067.50

STENT GRAFT 10FR 13MM X 10 CM

Facility

$20,450.00

Service Code	HCPCS C1874
Hospital Charge Code	270692120
Hospital Revenue Code	278
Min. Negotiated Rate	$492.85
Max. Negotiated Rate	$10,225.00
Rate for Payer: Aetna Commercial	$7,771.00
Rate for Payer: Aetna Medicare Advantage	$6,135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,214.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,214.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,090.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,214.75
Rate for Payer: Cigna Commercial	$10,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,948.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,499.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,067.50
Rate for Payer: UnitedHealthcare Community & State	$492.85
Rate for Payer: Wellpoint Medicaid Managed Care	$541.92

STENT GRAFT 10FR 13MM X 10 CM

Facility

$20,450.00

Service Code	HCPCS C1874
Hospital Charge Code	270692120
Hospital Revenue Code	278
Min. Negotiated Rate	$3,067.50
Max. Negotiated Rate	$4,948.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,090.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,948.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,499.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,067.50

STENT GRAFT 20-13x88

Facility

$17,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270672011
Hospital Revenue Code	278
Min. Negotiated Rate	$421.63
Max. Negotiated Rate	$8,747.50
Rate for Payer: Aetna Commercial	$6,648.10
Rate for Payer: Aetna Medicare Advantage	$5,248.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,461.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,461.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,499.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,461.23
Rate for Payer: Cigna Commercial	$8,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,233.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,848.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,624.25
Rate for Payer: UnitedHealthcare Community & State	$421.63
Rate for Payer: Wellpoint Medicaid Managed Care	$463.62

STENT GRAFT 20-13x88

Facility

$17,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270672011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,624.25
Max. Negotiated Rate	$4,233.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,499.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,233.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,848.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,624.25

STENT GRAFT AORTIC YRECX26375

Facility

$10,044.00

Hospital Charge Code	270631401
Hospital Revenue Code	278
Min. Negotiated Rate	$242.06
Max. Negotiated Rate	$5,022.00
Rate for Payer: Aetna Commercial	$3,816.72
Rate for Payer: Aetna Medicare Advantage	$3,013.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,561.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,561.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,008.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,561.22
Rate for Payer: Cigna Commercial	$5,022.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,430.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,209.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,506.60
Rate for Payer: UnitedHealthcare Community & State	$242.06
Rate for Payer: Wellpoint Medicaid Managed Care	$266.17

STENT GRAFT AORTIC YRECX26375

Facility

$10,044.00

Hospital Charge Code	270631401
Hospital Revenue Code	278
Min. Negotiated Rate	$1,506.60
Max. Negotiated Rate	$2,430.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,008.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,430.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,209.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,506.60

STENT GRAFT AORTIC YRECX28375

Facility

$10,044.00

Hospital Charge Code	270629599
Hospital Revenue Code	278
Min. Negotiated Rate	$1,506.60
Max. Negotiated Rate	$2,430.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,008.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,430.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,209.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,506.60

STENT GRAFT AORTIC YRECX28375

Facility

$10,044.00

Hospital Charge Code	270629599
Hospital Revenue Code	278
Min. Negotiated Rate	$242.06
Max. Negotiated Rate	$5,022.00
Rate for Payer: Aetna Commercial	$3,816.72
Rate for Payer: Aetna Medicare Advantage	$3,013.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,561.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,561.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,008.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,561.22
Rate for Payer: Cigna Commercial	$5,022.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,430.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,209.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,506.60
Rate for Payer: UnitedHealthcare Community & State	$242.06
Rate for Payer: Wellpoint Medicaid Managed Care	$266.17

STENT GRAFT BA22-80/120-40

Facility

$57,900.00

Hospital Charge Code	270659187C
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$14,011.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,738.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

STENT GRAFT BA22-80/120-40

Facility

$57,900.00

Hospital Charge Code	270659187C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,395.39
Max. Negotiated Rate	$28,950.00
Rate for Payer: Aetna Commercial	$22,002.00
Rate for Payer: Aetna Medicare Advantage	$17,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,764.50
Rate for Payer: Cigna Commercial	$28,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,738.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00
Rate for Payer: UnitedHealthcare Community & State	$1,395.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1,534.35

STENT GRAFT BA25-110/120-30

Facility

$57,900.00

Hospital Charge Code	270659157C
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$14,011.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,738.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

STENT GRAFT BA25-110/120-30

Facility

$57,900.00

Hospital Charge Code	270659157C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,395.39
Max. Negotiated Rate	$28,950.00
Rate for Payer: Aetna Commercial	$22,002.00
Rate for Payer: Aetna Medicare Advantage	$17,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,764.50
Rate for Payer: Cigna Commercial	$28,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,738.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00
Rate for Payer: UnitedHealthcare Community & State	$1,395.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1,534.35

STENT GRAFT BALLOOM Q50X

Facility

$4,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270689534
Hospital Revenue Code	278
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$1,028.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$935.00
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

STENT GRAFT BALLOOM Q50X

Facility

$4,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270689534
Hospital Revenue Code	278
Min. Negotiated Rate	$102.42
Max. Negotiated Rate	$2,125.00
Rate for Payer: Aetna Commercial	$1,615.00
Rate for Payer: Aetna Medicare Advantage	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,083.75
Rate for Payer: Cigna Commercial	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$935.00
Rate for Payer: Qualcare PPO/HMO/WC	$637.50
Rate for Payer: UnitedHealthcare Community & State	$102.42
Rate for Payer: Wellpoint Medicaid Managed Care	$112.62

STENTGRAFTBEA28-60/I16-40AFX2

Facility

$65,795.00

Service Code	HCPCS C1889
Hospital Charge Code	270684061V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,585.66
Max. Negotiated Rate	$32,897.50
Rate for Payer: Aetna Commercial	$25,002.10
Rate for Payer: Aetna Medicare Advantage	$19,738.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,777.72
Rate for Payer: Cigna Commercial	$32,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,474.90
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25
Rate for Payer: UnitedHealthcare Community & State	$1,585.66
Rate for Payer: Wellpoint Medicaid Managed Care	$1,743.57

STENTGRAFTBEA28-60/I16-40AFX2

Facility

$65,795.00

Service Code	HCPCS C1889
Hospital Charge Code	270684061V
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$15,922.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,474.90
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

STENT GRAFT FLUENCY 10X40MM

Facility

$9,250.00

Hospital Charge Code	270669231
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 GRAFT FLUENCY 10X40MM

Facility

$9,250.00

Hospital Charge Code	270669231
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 GRAFT FLUENCY 6X60

Facility

$14,250.00

Hospital Charge Code	270639112
Hospital Revenue Code	278
Min. Negotiated Rate	$343.43
Max. Negotiated Rate	$7,125.00
Rate for Payer: Aetna Commercial	$5,415.00
Rate for Payer: Aetna Medicare Advantage	$4,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,633.75
Rate for Payer: Cigna Commercial	$7,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,135.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50
Rate for Payer: UnitedHealthcare Community & State	$343.43
Rate for Payer: Wellpoint Medicaid Managed Care	$377.62

STENT GRAFT FLUENCY 6X60

Facility

$14,250.00

Hospital Charge Code	270639112
Hospital Revenue Code	278
Min. Negotiated Rate	$2,137.50
Max. Negotiated Rate	$3,448.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,135.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50

STENT GRAFT FLUENCY 8X40MM

Facility

$9,250.00

Hospital Charge Code	270669232
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 GRAFT FLUENCY 8X40MM

Facility

$9,250.00

Hospital Charge Code	270669232
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 GRAFT FLUENCY PLUS 8X60

Facility

$15,715.00

Service Code	HCPCS C1876
Hospital Charge Code	270637894C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,357.25
Max. Negotiated Rate	$3,803.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,143.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,803.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,457.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,357.25

STENT GRAFT FLUENCY PLUS 8X60

Facility

$15,715.00

Service Code	HCPCS C1876
Hospital Charge Code	270637894N
Hospital Revenue Code	278
Min. Negotiated Rate	$378.73
Max. Negotiated Rate	$7,857.50
Rate for Payer: Aetna Commercial	$5,971.70
Rate for Payer: Aetna Medicare Advantage	$4,714.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,007.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,007.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,143.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,007.32
Rate for Payer: Cigna Commercial	$7,857.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,803.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,457.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,357.25
Rate for Payer: UnitedHealthcare Community & State	$378.73
Rate for Payer: Wellpoint Medicaid Managed Care	$416.45

Know your out-of-pocket cost for care.

All Charges