Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT WALL 10FR 18x90mm 75cm

Facility

$9,000.00

Service Code	HCPCS C1784
Hospital Charge Code	270678423
Hospital Revenue Code	278
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$2,178.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,980.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00

STENT WALL 10FR 18x90mm 75cm

Facility

$9,000.00

Service Code	HCPCS C1784
Hospital Charge Code	270678423
Hospital Revenue Code	278
Min. Negotiated Rate	$216.90
Max. Negotiated Rate	$4,500.00
Rate for Payer: Aetna Commercial	$3,420.00
Rate for Payer: Aetna Medicare Advantage	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,295.00
Rate for Payer: Cigna Commercial	$4,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,980.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00
Rate for Payer: UnitedHealthcare Community & State	$216.90
Rate for Payer: Wellpoint Medicaid Managed Care	$238.50

STENT WALL 18/23X103 M00516900

Facility

$11,750.00

Hospital Charge Code	270641747
Hospital Revenue Code	278
Min. Negotiated Rate	$1,762.50
Max. Negotiated Rate	$2,843.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,843.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,585.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,762.50

STENT WALL 18/23X103 M00516900

Facility

$11,750.00

Hospital Charge Code	270641747
Hospital Revenue Code	278
Min. Negotiated Rate	$283.18
Max. Negotiated Rate	$5,875.00
Rate for Payer: Aetna Commercial	$4,465.00
Rate for Payer: Aetna Medicare Advantage	$3,525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,996.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,996.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,996.25
Rate for Payer: Cigna Commercial	$5,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,843.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,585.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,762.50
Rate for Payer: UnitedHealthcare Community & State	$283.18
Rate for Payer: Wellpoint Medicaid Managed Care	$311.38

STENT WALL 18/23X123 M00516910

Facility

$11,750.00

Hospital Charge Code	270641748
Hospital Revenue Code	278
Min. Negotiated Rate	$283.18
Max. Negotiated Rate	$5,875.00
Rate for Payer: Aetna Commercial	$4,465.00
Rate for Payer: Aetna Medicare Advantage	$3,525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,996.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,996.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,996.25
Rate for Payer: Cigna Commercial	$5,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,843.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,585.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,762.50
Rate for Payer: UnitedHealthcare Community & State	$283.18
Rate for Payer: Wellpoint Medicaid Managed Care	$311.38

STENT WALL 18/23X123 M00516910

Facility

$11,750.00

Hospital Charge Code	270641748
Hospital Revenue Code	278
Min. Negotiated Rate	$1,762.50
Max. Negotiated Rate	$2,843.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,843.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,585.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,762.50

STENT WALL 4X40

Facility

$5,250.00

Hospital Charge Code	270627758
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

STENT WALL 4X40

Facility

$5,250.00

Hospital Charge Code	270627758
Hospital Revenue Code	278
Min. Negotiated Rate	$126.53
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$126.53
Rate for Payer: Wellpoint Medicaid Managed Care	$139.12

STENT WALL ENDOPROSTHESI 40331

Facility

$5,319.60

Hospital Charge Code	270627282V
Hospital Revenue Code	278
Min. Negotiated Rate	$128.20
Max. Negotiated Rate	$2,659.80
Rate for Payer: Aetna Commercial	$2,021.45
Rate for Payer: Aetna Medicare Advantage	$1,595.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,356.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,356.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,063.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,356.50
Rate for Payer: Cigna Commercial	$2,659.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,287.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,170.31
Rate for Payer: Qualcare PPO/HMO/WC	$797.94
Rate for Payer: UnitedHealthcare Community & State	$128.20
Rate for Payer: Wellpoint Medicaid Managed Care	$140.97

STENT WALL ENDOPROSTHESI 40331

Facility

$5,319.60

Hospital Charge Code	270627282V
Hospital Revenue Code	278
Min. Negotiated Rate	$797.94
Max. Negotiated Rate	$1,287.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,063.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,287.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,170.31
Rate for Payer: Qualcare PPO/HMO/WC	$797.94

STENT WALLFELX BILI 10x40 7052

Facility

$12,995.00

Service Code	HCPCS C1876
Hospital Charge Code	270643124
Hospital Revenue Code	278
Min. Negotiated Rate	$1,949.25
Max. Negotiated Rate	$3,144.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,144.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,858.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.25

STENT WALLFELX BILI 10x40 7052

Facility

$12,995.00

Service Code	HCPCS C1876
Hospital Charge Code	270643124
Hospital Revenue Code	278
Min. Negotiated Rate	$313.18
Max. Negotiated Rate	$6,497.50
Rate for Payer: Aetna Commercial	$4,938.10
Rate for Payer: Aetna Medicare Advantage	$3,898.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,313.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,313.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,313.72
Rate for Payer: Cigna Commercial	$6,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,144.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,858.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.25
Rate for Payer: UnitedHealthcare Community & State	$313.18
Rate for Payer: Wellpoint Medicaid Managed Care	$344.37

STENT WALLFLEX 10MM X 40MM

Facility

$12,995.00

Service Code	HCPCS C1784
Hospital Charge Code	270680142
Hospital Revenue Code	278
Min. Negotiated Rate	$1,949.25
Max. Negotiated Rate	$3,144.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,144.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,858.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.25

STENT WALLFLEX 10MM X 40MM

Facility

$12,995.00

Service Code	HCPCS C1784
Hospital Charge Code	270680142
Hospital Revenue Code	278
Min. Negotiated Rate	$313.18
Max. Negotiated Rate	$6,497.50
Rate for Payer: Aetna Commercial	$4,938.10
Rate for Payer: Aetna Medicare Advantage	$3,898.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,313.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,313.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,313.72
Rate for Payer: Cigna Commercial	$6,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,144.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,858.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.25
Rate for Payer: UnitedHealthcare Community & State	$313.18
Rate for Payer: Wellpoint Medicaid Managed Care	$344.37

STENT WALLFLEX 10x40

Facility

$14,995.00

Hospital Charge Code	270648051
Hospital Revenue Code	278
Min. Negotiated Rate	$361.38
Max. Negotiated Rate	$7,497.50
Rate for Payer: Aetna Commercial	$5,698.10
Rate for Payer: Aetna Medicare Advantage	$4,498.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,823.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,823.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,999.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,823.72
Rate for Payer: Cigna Commercial	$7,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,628.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,298.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,249.25
Rate for Payer: UnitedHealthcare Community & State	$361.38
Rate for Payer: Wellpoint Medicaid Managed Care	$397.37

STENT WALLFLEX 10x40

Facility

$14,995.00

Hospital Charge Code	270648051
Hospital Revenue Code	278
Min. Negotiated Rate	$2,249.25
Max. Negotiated Rate	$3,628.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,999.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,628.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,298.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,249.25

STENT WALLFLEX 10X40

Facility

$14,995.00

Hospital Charge Code	270648051C
Hospital Revenue Code	278
Min. Negotiated Rate	$361.38
Max. Negotiated Rate	$7,497.50
Rate for Payer: Aetna Commercial	$5,698.10
Rate for Payer: Aetna Medicare Advantage	$4,498.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,823.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,823.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,999.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,823.72
Rate for Payer: Cigna Commercial	$7,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,628.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,298.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,249.25
Rate for Payer: UnitedHealthcare Community & State	$361.38
Rate for Payer: Wellpoint Medicaid Managed Care	$397.37

STENT WALLFLEX 10X40

Facility

$14,995.00

Hospital Charge Code	270648051C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,249.25
Max. Negotiated Rate	$3,628.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,999.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,628.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,298.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,249.25

STENT WALLFLEX 120MM

Facility

$12,875.00

Hospital Charge Code	270662150
Hospital Revenue Code	278
Min. Negotiated Rate	$1,931.25
Max. Negotiated Rate	$3,115.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,115.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,832.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,931.25

STENT WALLFLEX 120MM

Facility

$12,875.00

Hospital Charge Code	270662150
Hospital Revenue Code	278
Min. Negotiated Rate	$310.29
Max. Negotiated Rate	$6,437.50
Rate for Payer: Aetna Commercial	$4,892.50
Rate for Payer: Aetna Medicare Advantage	$3,862.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,283.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,283.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,283.12
Rate for Payer: Cigna Commercial	$6,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,115.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,832.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,931.25
Rate for Payer: UnitedHealthcare Community & State	$310.29
Rate for Payer: Wellpoint Medicaid Managed Care	$341.19

STENT WALLFLEX 23X10.5

Facility

$12,047.05

Service Code	HCPCS C1876
Hospital Charge Code	270643744
Hospital Revenue Code	278
Min. Negotiated Rate	$1,807.06
Max. Negotiated Rate	$2,915.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,409.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,915.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,650.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,807.06

STENT WALLFLEX 23X10.5

Facility

$12,047.05

Service Code	HCPCS C1876
Hospital Charge Code	270643744
Hospital Revenue Code	278
Min. Negotiated Rate	$290.33
Max. Negotiated Rate	$6,023.52
Rate for Payer: Aetna Commercial	$4,577.88
Rate for Payer: Aetna Medicare Advantage	$3,614.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,072.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,072.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,409.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,072.00
Rate for Payer: Cigna Commercial	$6,023.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,915.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,650.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,807.06
Rate for Payer: UnitedHealthcare Community & State	$290.33
Rate for Payer: Wellpoint Medicaid Managed Care	$319.25

STENT WALLFLEX 27/22X 10 60 CM

Facility

$12,975.00

Service Code	HCPCS C1876
Hospital Charge Code	270663057
Hospital Revenue Code	278
Min. Negotiated Rate	$1,946.25
Max. Negotiated Rate	$3,139.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,139.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,854.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,946.25

STENT WALLFLEX 27/22X 10 60 CM

Facility

$12,975.00

Service Code	HCPCS C1876
Hospital Charge Code	270663057
Hospital Revenue Code	278
Min. Negotiated Rate	$312.70
Max. Negotiated Rate	$6,487.50
Rate for Payer: Aetna Commercial	$4,930.50
Rate for Payer: Aetna Medicare Advantage	$3,892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,308.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,308.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,308.62
Rate for Payer: Cigna Commercial	$6,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,139.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,854.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,946.25
Rate for Payer: UnitedHealthcare Community & State	$312.70
Rate for Payer: Wellpoint Medicaid Managed Care	$343.84

STENT WALLFLEX 27/22X 12 230CM

Facility

$12,975.00

Hospital Charge Code	270648012
Hospital Revenue Code	278
Min. Negotiated Rate	$1,946.25
Max. Negotiated Rate	$3,139.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,139.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,854.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,946.25

Know your out-of-pocket cost for care.

All Charges