Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT GRAFT FLUENCY PLUS 8X60

Facility

$13,570.00

Hospital Charge Code	270937894
Hospital Revenue Code	278
Min. Negotiated Rate	$327.04
Max. Negotiated Rate	$6,785.00
Rate for Payer: Aetna Commercial	$5,156.60
Rate for Payer: Aetna Medicare Advantage	$4,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,714.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,460.35
Rate for Payer: Cigna Commercial	$6,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,283.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,985.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50
Rate for Payer: UnitedHealthcare Community & State	$327.04
Rate for Payer: Wellpoint Medicaid Managed Care	$359.61

STENT GRAFT FLUENCY PLUS 8X60

Facility

$13,570.00

Hospital Charge Code	270937894
Hospital Revenue Code	278
Min. Negotiated Rate	$2,035.50
Max. Negotiated Rate	$3,283.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,714.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,283.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,985.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

STENT GRAFT FLUENCY PLUS 8X60

Facility

$15,715.00

Service Code	HCPCS C1876
Hospital Charge Code	270637894C
Hospital Revenue Code	278
Min. Negotiated Rate	$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

STENT GRAFT FLUENCY PLUS 8X60

Facility

$15,715.00

Service Code	HCPCS C1876
Hospital Charge Code	270637894N
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 FLY 10x60 FLT10060

Facility

$13,570.00

Hospital Charge Code	270634920V
Hospital Revenue Code	278
Min. Negotiated Rate	$327.04
Max. Negotiated Rate	$6,785.00
Rate for Payer: Aetna Commercial	$5,156.60
Rate for Payer: Aetna Medicare Advantage	$4,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,714.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,460.35
Rate for Payer: Cigna Commercial	$6,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,283.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,985.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50
Rate for Payer: UnitedHealthcare Community & State	$327.04
Rate for Payer: Wellpoint Medicaid Managed Care	$359.61

STENT GRAFT FLY 10x60 FLT10060

Facility

$13,570.00

Hospital Charge Code	270634920V
Hospital Revenue Code	278
Min. Negotiated Rate	$2,035.50
Max. Negotiated Rate	$3,283.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,714.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,283.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,985.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

STENT GRAFT ILIAC EX 12mmX12mm

Facility

$23,495.00

Service Code	HCPCS C1763
Hospital Charge Code	270680927
Hospital Revenue Code	278
Min. Negotiated Rate	$3,524.25
Max. Negotiated Rate	$5,685.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,168.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25

STENT GRAFT ILIAC EX 12mmX12mm

Facility

$23,495.00

Service Code	HCPCS C1763
Hospital Charge Code	270680927
Hospital Revenue Code	278
Min. Negotiated Rate	$566.23
Max. Negotiated Rate	$11,747.50
Rate for Payer: Aetna Commercial	$8,928.10
Rate for Payer: Aetna Medicare Advantage	$7,048.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,991.23
Rate for Payer: Cigna Commercial	$11,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,168.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25
Rate for Payer: UnitedHealthcare Community & State	$566.23
Rate for Payer: Wellpoint Medicaid Managed Care	$622.62

STENT GRAFT ILLIAC YRIRX15115

Facility

$12,028.00

Hospital Charge Code	270631398
Hospital Revenue Code	278
Min. Negotiated Rate	$289.87
Max. Negotiated Rate	$6,014.00
Rate for Payer: Aetna Commercial	$4,570.64
Rate for Payer: Aetna Medicare Advantage	$3,608.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,067.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,067.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,405.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,067.14
Rate for Payer: Cigna Commercial	$6,014.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,910.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,646.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,804.20
Rate for Payer: UnitedHealthcare Community & State	$289.87
Rate for Payer: Wellpoint Medicaid Managed Care	$318.74

STENT GRAFT ILLIAC YRIRX15115

Facility

$12,028.00

Hospital Charge Code	270631398
Hospital Revenue Code	278
Min. Negotiated Rate	$1,804.20
Max. Negotiated Rate	$2,910.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,405.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,910.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,646.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,804.20

STENT GRAFT ILLIAC YRIRX1585

Facility

$11,036.00

Hospital Charge Code	270631399
Hospital Revenue Code	278
Min. Negotiated Rate	$1,655.40
Max. Negotiated Rate	$2,670.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,207.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,670.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,427.92
Rate for Payer: Qualcare PPO/HMO/WC	$1,655.40

STENT GRAFT ILLIAC YRIRX1585

Facility

$11,036.00

Hospital Charge Code	270631399
Hospital Revenue Code	278
Min. Negotiated Rate	$265.97
Max. Negotiated Rate	$5,518.00
Rate for Payer: Aetna Commercial	$4,193.68
Rate for Payer: Aetna Medicare Advantage	$3,310.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,814.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,814.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,207.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,814.18
Rate for Payer: Cigna Commercial	$5,518.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,670.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,427.92
Rate for Payer: Qualcare PPO/HMO/WC	$1,655.40
Rate for Payer: UnitedHealthcare Community & State	$265.97
Rate for Payer: Wellpoint Medicaid Managed Care	$292.45

STENT GRAFT MASTER 2.8MMX16MM

Facility

$11,975.00

Service Code	HCPCS C1874
Hospital Charge Code	270691783
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$2,897.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,634.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

STENT GRAFT MASTER 2.8MMX16MM

Facility

$11,975.00

Service Code	HCPCS C1874
Hospital Charge Code	270691783
Hospital Revenue Code	278
Min. Negotiated Rate	$288.60
Max. Negotiated Rate	$5,987.50
Rate for Payer: Aetna Commercial	$4,550.50
Rate for Payer: Aetna Medicare Advantage	$3,592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,053.62
Rate for Payer: Cigna Commercial	$5,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,634.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25
Rate for Payer: UnitedHealthcare Community & State	$288.60
Rate for Payer: Wellpoint Medicaid Managed Care	$317.34

STENT GRAFTMASTER 2.8x19mm

Facility

$11,975.00

Service Code	HCPCS C1874
Hospital Charge Code	270668169
Hospital Revenue Code	278
Min. Negotiated Rate	$288.60
Max. Negotiated Rate	$5,987.50
Rate for Payer: Aetna Commercial	$4,550.50
Rate for Payer: Aetna Medicare Advantage	$3,592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,053.62
Rate for Payer: Cigna Commercial	$5,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,634.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25
Rate for Payer: UnitedHealthcare Community & State	$288.60
Rate for Payer: Wellpoint Medicaid Managed Care	$317.34

STENT GRAFTMASTER 2.8x19mm

Facility

$11,975.00

Service Code	HCPCS C1874
Hospital Charge Code	270668169
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$2,897.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,634.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

STENT GRAFT MASTER 3.5MMX16MM

Facility

$11,625.00

Service Code	HCPCS C1874
Hospital Charge Code	270691785
Hospital Revenue Code	278
Min. Negotiated Rate	$1,743.75
Max. Negotiated Rate	$2,813.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,813.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,557.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,743.75

STENT GRAFT MASTER 3.5MMX16MM

Facility

$12,910.00

Service Code	HCPCS C1874
Hospital Charge Code	270691784
Hospital Revenue Code	278
Min. Negotiated Rate	$1,936.50
Max. Negotiated Rate	$3,124.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,582.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,124.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,840.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,936.50

STENT GRAFT MASTER 3.5MMX16MM

Facility

$11,625.00

Service Code	HCPCS C1874
Hospital Charge Code	270691785
Hospital Revenue Code	278
Min. Negotiated Rate	$280.16
Max. Negotiated Rate	$5,812.50
Rate for Payer: Aetna Commercial	$4,417.50
Rate for Payer: Aetna Medicare Advantage	$3,487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,964.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,964.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,964.38
Rate for Payer: Cigna Commercial	$5,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,813.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,557.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,743.75
Rate for Payer: UnitedHealthcare Community & State	$280.16
Rate for Payer: Wellpoint Medicaid Managed Care	$308.06

STENT GRAFT MASTER 3.5MMX16MM

Facility

$12,910.00

Service Code	HCPCS C1874
Hospital Charge Code	270691784
Hospital Revenue Code	278
Min. Negotiated Rate	$311.13
Max. Negotiated Rate	$6,455.00
Rate for Payer: Aetna Commercial	$4,905.80
Rate for Payer: Aetna Medicare Advantage	$3,873.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,292.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,292.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,582.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,292.05
Rate for Payer: Cigna Commercial	$6,455.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,124.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,840.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,936.50
Rate for Payer: UnitedHealthcare Community & State	$311.13
Rate for Payer: Wellpoint Medicaid Managed Care	$342.12

STENT GRAFTMASTER 3.5X19MM

Facility

$11,975.00

Hospital Charge Code	270636151
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$2,897.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,634.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

STENT GRAFTMASTER 3.5X19MM

Facility

$11,975.00

Hospital Charge Code	270636151
Hospital Revenue Code	278
Min. Negotiated Rate	$288.60
Max. Negotiated Rate	$5,987.50
Rate for Payer: Aetna Commercial	$4,550.50
Rate for Payer: Aetna Medicare Advantage	$3,592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,053.62
Rate for Payer: Cigna Commercial	$5,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,634.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25
Rate for Payer: UnitedHealthcare Community & State	$288.60
Rate for Payer: Wellpoint Medicaid Managed Care	$317.34

STENT GRAFTMASTER 3x19 1274419

Facility

$11,975.00

Hospital Charge Code	270636150V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$2,897.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,634.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

STENT GRAFTMASTER 3x19 1274419

Facility

$11,975.00

Hospital Charge Code	270636150V
Hospital Revenue Code	278
Min. Negotiated Rate	$288.60
Max. Negotiated Rate	$5,987.50
Rate for Payer: Aetna Commercial	$4,550.50
Rate for Payer: Aetna Medicare Advantage	$3,592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,053.62
Rate for Payer: Cigna Commercial	$5,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,634.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25
Rate for Payer: UnitedHealthcare Community & State	$288.60
Rate for Payer: Wellpoint Medicaid Managed Care	$317.34

STENT GRAFTMASTER 4.0X19MM

Facility

$11,975.00

Hospital Charge Code	270636152
Hospital Revenue Code	278
Min. Negotiated Rate	$288.60
Max. Negotiated Rate	$5,987.50
Rate for Payer: Aetna Commercial	$4,550.50
Rate for Payer: Aetna Medicare Advantage	$3,592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,053.62
Rate for Payer: Cigna Commercial	$5,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,634.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25
Rate for Payer: UnitedHealthcare Community & State	$288.60
Rate for Payer: Wellpoint Medicaid Managed Care	$317.34

Know your out-of-pocket cost for care.

All Charges