Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT TRACHEAL SIZE 40 6957

Facility

$8,400.00

Hospital Charge Code	270638727V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,260.00
Max. Negotiated Rate	$2,032.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,680.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,032.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,848.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,260.00

STENT TRACHEAL SIZE 40 6957

Facility

$8,400.00

Hospital Charge Code	270638727V
Hospital Revenue Code	278
Min. Negotiated Rate	$202.44
Max. Negotiated Rate	$4,200.00
Rate for Payer: Aetna Commercial	$3,192.00
Rate for Payer: Aetna Medicare Advantage	$2,520.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,142.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,142.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,680.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,142.00
Rate for Payer: Cigna Commercial	$4,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,032.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,848.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,260.00
Rate for Payer: UnitedHealthcare Community & State	$202.44
Rate for Payer: Wellpoint Medicaid Managed Care	$222.60

STENT TRACHEAL SIZE 60

Facility

$8,400.00

Hospital Charge Code	270638729
Hospital Revenue Code	278
Min. Negotiated Rate	$1,260.00
Max. Negotiated Rate	$2,032.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,680.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,032.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,848.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,260.00

STENT TRACHEAL SIZE 60

Facility

$8,400.00

Hospital Charge Code	270638729
Hospital Revenue Code	278
Min. Negotiated Rate	$202.44
Max. Negotiated Rate	$4,200.00
Rate for Payer: Aetna Commercial	$3,192.00
Rate for Payer: Aetna Medicare Advantage	$2,520.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,142.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,142.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,680.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,142.00
Rate for Payer: Cigna Commercial	$4,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,032.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,848.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,260.00
Rate for Payer: UnitedHealthcare Community & State	$202.44
Rate for Payer: Wellpoint Medicaid Managed Care	$222.60

STENT TRACH P/COVRD 12x40x25MM

Facility

$16,500.00

Service Code	HCPCS C1874
Hospital Charge Code	270676648
Hospital Revenue Code	278
Min. Negotiated Rate	$2,475.00
Max. Negotiated Rate	$3,993.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,993.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00

STENT TRACH P/COVRD 12x40x25MM

Facility

$16,500.00

Service Code	HCPCS C1874
Hospital Charge Code	270676648
Hospital Revenue Code	278
Min. Negotiated Rate	$397.65
Max. Negotiated Rate	$8,250.00
Rate for Payer: Aetna Commercial	$6,270.00
Rate for Payer: Aetna Medicare Advantage	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,207.50
Rate for Payer: Cigna Commercial	$8,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,993.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00
Rate for Payer: UnitedHealthcare Community & State	$397.65
Rate for Payer: Wellpoint Medicaid Managed Care	$437.25

STENT TRACH P/COVRD 14x40x40MM

Facility

$16,500.00

Service Code	HCPCS C1874
Hospital Charge Code	270677586
Hospital Revenue Code	278
Min. Negotiated Rate	$397.65
Max. Negotiated Rate	$8,250.00
Rate for Payer: Aetna Commercial	$6,270.00
Rate for Payer: Aetna Medicare Advantage	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,207.50
Rate for Payer: Cigna Commercial	$8,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,993.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00
Rate for Payer: UnitedHealthcare Community & State	$397.65
Rate for Payer: Wellpoint Medicaid Managed Care	$437.25

STENT TRACH P/COVRD 14x40x40MM

Facility

$16,500.00

Service Code	HCPCS C1874
Hospital Charge Code	270677586
Hospital Revenue Code	278
Min. Negotiated Rate	$2,475.00
Max. Negotiated Rate	$3,993.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,993.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00

STENT TRACH P/COVRD 16x40x40MM

Facility

$16,500.00

Hospital Charge Code	270677587
Hospital Revenue Code	278
Min. Negotiated Rate	$2,475.00
Max. Negotiated Rate	$3,993.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,993.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00

STENT TRACH P/COVRD 16x40x40MM

Facility

$16,500.00

Hospital Charge Code	270677587
Hospital Revenue Code	278
Min. Negotiated Rate	$397.65
Max. Negotiated Rate	$8,250.00
Rate for Payer: Aetna Commercial	$6,270.00
Rate for Payer: Aetna Medicare Advantage	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,207.50
Rate for Payer: Cigna Commercial	$8,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,993.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00
Rate for Payer: UnitedHealthcare Community & State	$397.65
Rate for Payer: Wellpoint Medicaid Managed Care	$437.25

STENT TREVO 3 X 20 CM

Facility

$39,975.00

Hospital Charge Code	270685068
Hospital Revenue Code	278
Min. Negotiated Rate	$963.40
Max. Negotiated Rate	$19,987.50
Rate for Payer: Aetna Commercial	$15,190.50
Rate for Payer: Aetna Medicare Advantage	$11,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,193.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,193.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,193.62
Rate for Payer: Cigna Commercial	$19,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,673.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,794.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,996.25
Rate for Payer: UnitedHealthcare Community & State	$963.40
Rate for Payer: Wellpoint Medicaid Managed Care	$1,059.34

STENT TREVO 3 X 20 CM

Facility

$39,975.00

Hospital Charge Code	270685068
Hospital Revenue Code	278
Min. Negotiated Rate	$5,996.25
Max. Negotiated Rate	$9,673.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,673.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,794.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,996.25

STENT TX EXP 2 75X32 389703227

Facility

$13,625.00

Hospital Charge Code	270637365
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 TX EXP 2 75X32 389703227

Facility

$13,625.00

Hospital Charge Code	270637365
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

STENT TX XPEDITION 2.75X18

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658768
Hospital Revenue Code	278
Min. Negotiated Rate	$168.70
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,660.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$168.70
Rate for Payer: Wellpoint Medicaid Managed Care	$185.50

STENT TX XPEDITION 2.75X18

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT ULTRAFLEX TRACH 18X80MM

Facility

$16,500.00

Hospital Charge Code	270671168
Hospital Revenue Code	278
Min. Negotiated Rate	$2,475.00
Max. Negotiated Rate	$3,993.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,993.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00

STENT ULTRAFLEX TRACH 18X80MM

Facility

$16,500.00

Hospital Charge Code	270671168
Hospital Revenue Code	278
Min. Negotiated Rate	$397.65
Max. Negotiated Rate	$8,250.00
Rate for Payer: Aetna Commercial	$6,270.00
Rate for Payer: Aetna Medicare Advantage	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,207.50
Rate for Payer: Cigna Commercial	$8,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,993.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00
Rate for Payer: UnitedHealthcare Community & State	$397.65
Rate for Payer: Wellpoint Medicaid Managed Care	$437.25

STENT ULTRAFLEX TRACHEOBRONCHI

Facility

$12,130.00

Hospital Charge Code	270667714
Hospital Revenue Code	278
Min. Negotiated Rate	$292.33
Max. Negotiated Rate	$6,065.00
Rate for Payer: Aetna Commercial	$4,609.40
Rate for Payer: Aetna Medicare Advantage	$3,639.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,093.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,093.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,426.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,093.15
Rate for Payer: Cigna Commercial	$6,065.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,935.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,668.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,819.50
Rate for Payer: UnitedHealthcare Community & State	$292.33
Rate for Payer: Wellpoint Medicaid Managed Care	$321.44

STENT ULTRAFLEX TRACHEOBRONCHI

Facility

$12,130.00

Hospital Charge Code	270667714
Hospital Revenue Code	278
Min. Negotiated Rate	$1,819.50
Max. Negotiated Rate	$2,935.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,426.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,935.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,668.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,819.50

STENT ULTRAFLEX TRACHEOBRONCHI

Facility

$12,130.00

Hospital Charge Code	270665628
Hospital Revenue Code	278
Min. Negotiated Rate	$292.33
Max. Negotiated Rate	$6,065.00
Rate for Payer: Aetna Commercial	$4,609.40
Rate for Payer: Aetna Medicare Advantage	$3,639.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,093.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,093.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,426.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,093.15
Rate for Payer: Cigna Commercial	$6,065.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,935.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,668.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,819.50
Rate for Payer: UnitedHealthcare Community & State	$292.33
Rate for Payer: Wellpoint Medicaid Managed Care	$321.44

STENT ULTRAFLEX TRACHEOBRONCHI

Facility

$12,130.00

Hospital Charge Code	270665628
Hospital Revenue Code	278
Min. Negotiated Rate	$1,819.50
Max. Negotiated Rate	$2,935.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,426.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,935.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,668.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,819.50

STENT UNCOVERED BILIARY 8x10

Facility

$8,504.25

Service Code	HCPCS C1876
Hospital Charge Code	270677074
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.64
Max. Negotiated Rate	$2,058.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,058.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,870.93
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.64

STENT UNCOVERED BILIARY 8x10

Facility

$8,504.25

Service Code	HCPCS C1876
Hospital Charge Code	270677074
Hospital Revenue Code	278
Min. Negotiated Rate	$204.95
Max. Negotiated Rate	$4,252.12
Rate for Payer: Aetna Commercial	$3,231.61
Rate for Payer: Aetna Medicare Advantage	$2,551.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,168.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,168.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,168.58
Rate for Payer: Cigna Commercial	$4,252.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,058.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,870.93
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.64
Rate for Payer: UnitedHealthcare Community & State	$204.95
Rate for Payer: Wellpoint Medicaid Managed Care	$225.36

STENT UNIVERSA FIRM 6x22

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647871
Hospital Revenue Code	278
Min. Negotiated Rate	$10.90
Max. Negotiated Rate	$226.20
Rate for Payer: Aetna Commercial	$171.91
Rate for Payer: Aetna Medicare Advantage	$135.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.36
Rate for Payer: Cigna Commercial	$226.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.53
Rate for Payer: Qualcare PPO/HMO/WC	$67.86
Rate for Payer: UnitedHealthcare Community & State	$10.90
Rate for Payer: Wellpoint Medicaid Managed Care	$11.99

Know your out-of-pocket cost for care.

All Charges