Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT WALLFLEX 27/22X 12 230CM

Facility

$12,975.00

Hospital Charge Code	270648012
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 60MM

Facility

$12,875.00

Hospital Charge Code	270662148
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 60MM

Facility

$12,875.00

Hospital Charge Code	270662148
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 8MM X 8FR

Facility

$8,470.00

Service Code	HCPCS C1876
Hospital Charge Code	270688376
Hospital Revenue Code	278
Min. Negotiated Rate	$1,270.50
Max. Negotiated Rate	$2,049.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,694.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,049.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,863.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,270.50

STENT WALLFLEX 8MM X 8FR

Facility

$8,470.00

Service Code	HCPCS C1876
Hospital Charge Code	270688376
Hospital Revenue Code	278
Min. Negotiated Rate	$204.13
Max. Negotiated Rate	$4,235.00
Rate for Payer: Aetna Commercial	$3,218.60
Rate for Payer: Aetna Medicare Advantage	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,159.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,159.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,159.85
Rate for Payer: Cigna Commercial	$4,235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,049.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,863.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,270.50
Rate for Payer: UnitedHealthcare Community & State	$204.13
Rate for Payer: Wellpoint Medicaid Managed Care	$224.46

STENT WALLFLEX BILI 10x60 7053

Facility

$12,999.50

Service Code	HCPCS C1876
Hospital Charge Code	270642716
Hospital Revenue Code	278
Min. Negotiated Rate	$1,949.92
Max. Negotiated Rate	$3,145.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,145.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,859.89
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.92

STENT WALLFLEX BILI 10x60 7053

Facility

$12,999.50

Service Code	HCPCS C1876
Hospital Charge Code	270642716
Hospital Revenue Code	278
Min. Negotiated Rate	$313.29
Max. Negotiated Rate	$6,499.75
Rate for Payer: Aetna Commercial	$4,939.81
Rate for Payer: Aetna Medicare Advantage	$3,899.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,314.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,314.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,314.87
Rate for Payer: Cigna Commercial	$6,499.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,145.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,859.89
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.92
Rate for Payer: UnitedHealthcare Community & State	$313.29
Rate for Payer: Wellpoint Medicaid Managed Care	$344.49

STENT WALLFLEX BILI 10X60 7053

Facility

$14,175.00

Hospital Charge Code	270642716C
Hospital Revenue Code	278
Min. Negotiated Rate	$341.62
Max. Negotiated Rate	$7,087.50
Rate for Payer: Aetna Commercial	$5,386.50
Rate for Payer: Aetna Medicare Advantage	$4,252.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,614.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,614.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,614.62
Rate for Payer: Cigna Commercial	$7,087.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,430.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,118.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,126.25
Rate for Payer: UnitedHealthcare Community & State	$341.62
Rate for Payer: Wellpoint Medicaid Managed Care	$375.64

STENT WALLFLEX BILI 10X60 7053

Facility

$14,175.00

Hospital Charge Code	270642716C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,126.25
Max. Negotiated Rate	$3,430.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,835.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,430.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,118.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,126.25

STENT WALLFLEX BILI 10X60 7478

Facility

$15,000.00

Hospital Charge Code	270648050C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

STENT WALLFLEX BILI 10X60 7478

Facility

$15,000.00

Hospital Charge Code	270648050C
Hospital Revenue Code	278
Min. Negotiated Rate	$361.50
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$5,700.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00
Rate for Payer: UnitedHealthcare Community & State	$361.50
Rate for Payer: Wellpoint Medicaid Managed Care	$397.50

STENT WALLFLEX BILI 8X60 7050

Facility

$14,175.00

Hospital Charge Code	270645387C
Hospital Revenue Code	278
Min. Negotiated Rate	$341.62
Max. Negotiated Rate	$7,087.50
Rate for Payer: Aetna Commercial	$5,386.50
Rate for Payer: Aetna Medicare Advantage	$4,252.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,614.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,614.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,614.62
Rate for Payer: Cigna Commercial	$7,087.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,430.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,118.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,126.25
Rate for Payer: UnitedHealthcare Community & State	$341.62
Rate for Payer: Wellpoint Medicaid Managed Care	$375.64

STENT WALLFLEX BILI 8X60 7050

Facility

$14,175.00

Hospital Charge Code	270645387C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,126.25
Max. Negotiated Rate	$3,430.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,835.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,430.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,118.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,126.25

STENT WALLFLEX BILIARY 10*60MM

Facility

$14,175.00

Hospital Charge Code	270664732
Hospital Revenue Code	278
Min. Negotiated Rate	$2,126.25
Max. Negotiated Rate	$3,430.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,835.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,430.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,118.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,126.25

STENT WALLFLEX BILIARY 10*60MM

Facility

$14,175.00

Hospital Charge Code	270664732
Hospital Revenue Code	278
Min. Negotiated Rate	$341.62
Max. Negotiated Rate	$7,087.50
Rate for Payer: Aetna Commercial	$5,386.50
Rate for Payer: Aetna Medicare Advantage	$4,252.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,614.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,614.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,614.62
Rate for Payer: Cigna Commercial	$7,087.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,430.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,118.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,126.25
Rate for Payer: UnitedHealthcare Community & State	$341.62
Rate for Payer: Wellpoint Medicaid Managed Care	$375.64

STENT WALLFLEX BILIARY 10x40

Facility

$14,175.00

Hospital Charge Code	270644762
Hospital Revenue Code	278
Min. Negotiated Rate	$2,126.25
Max. Negotiated Rate	$3,430.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,835.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,430.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,118.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,126.25

STENT WALLFLEX BILIARY 10x40

Facility

$14,175.00

Hospital Charge Code	270644762
Hospital Revenue Code	278
Min. Negotiated Rate	$341.62
Max. Negotiated Rate	$7,087.50
Rate for Payer: Aetna Commercial	$5,386.50
Rate for Payer: Aetna Medicare Advantage	$4,252.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,614.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,614.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,614.62
Rate for Payer: Cigna Commercial	$7,087.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,430.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,118.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,126.25
Rate for Payer: UnitedHealthcare Community & State	$341.62
Rate for Payer: Wellpoint Medicaid Managed Care	$375.64

STENT WALLFLEX BILIARY 10x60

Facility

$14,175.00

Hospital Charge Code	270644763
Hospital Revenue Code	278
Min. Negotiated Rate	$2,126.25
Max. Negotiated Rate	$3,430.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,835.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,430.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,118.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,126.25

STENT WALLFLEX BILIARY 10x60

Facility

$14,175.00

Hospital Charge Code	270644763
Hospital Revenue Code	278
Min. Negotiated Rate	$341.62
Max. Negotiated Rate	$7,087.50
Rate for Payer: Aetna Commercial	$5,386.50
Rate for Payer: Aetna Medicare Advantage	$4,252.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,614.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,614.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,614.62
Rate for Payer: Cigna Commercial	$7,087.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,430.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,118.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,126.25
Rate for Payer: UnitedHealthcare Community & State	$341.62
Rate for Payer: Wellpoint Medicaid Managed Care	$375.64

STENT WALLFLEX BILIARY 10X60MM

Facility

$19,985.00

Service Code	HCPCS C1874
Hospital Charge Code	270648050
Hospital Revenue Code	278
Min. Negotiated Rate	$2,997.75
Max. Negotiated Rate	$4,836.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,997.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,836.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,396.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,997.75

STENT WALLFLEX BILIARY 10X60MM

Facility

$19,985.00

Service Code	HCPCS C1874
Hospital Charge Code	270648050
Hospital Revenue Code	278
Min. Negotiated Rate	$481.64
Max. Negotiated Rate	$9,992.50
Rate for Payer: Aetna Commercial	$7,594.30
Rate for Payer: Aetna Medicare Advantage	$5,995.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,096.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,096.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,997.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,096.18
Rate for Payer: Cigna Commercial	$9,992.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,836.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,396.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,997.75
Rate for Payer: UnitedHealthcare Community & State	$481.64
Rate for Payer: Wellpoint Medicaid Managed Care	$529.60

STENT WALLFLEX BILIARY 10x80

Facility

$12,999.50

Service Code	HCPCS C1876
Hospital Charge Code	270677877
Hospital Revenue Code	278
Min. Negotiated Rate	$313.29
Max. Negotiated Rate	$6,499.75
Rate for Payer: Aetna Commercial	$4,939.81
Rate for Payer: Aetna Medicare Advantage	$3,899.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,314.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,314.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,314.87
Rate for Payer: Cigna Commercial	$6,499.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,145.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,859.89
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.92
Rate for Payer: UnitedHealthcare Community & State	$313.29
Rate for Payer: Wellpoint Medicaid Managed Care	$344.49

STENT WALLFLEX BILIARY 10x80

Facility

$12,999.50

Service Code	HCPCS C1876
Hospital Charge Code	270677877
Hospital Revenue Code	278
Min. Negotiated Rate	$1,949.92
Max. Negotiated Rate	$3,145.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,145.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,859.89
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.92

STENT WALLFLEX BILIARY 10X80

Facility

$12,999.50

Service Code	HCPCS C1876
Hospital Charge Code	270646676C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,949.92
Max. Negotiated Rate	$3,145.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,145.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,859.89
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.92

STENT WALLFLEX BILIARY 10X80

Facility

$14,175.00

Service Code	HCPCS C1876
Hospital Charge Code	270646676N
Hospital Revenue Code	278
Min. Negotiated Rate	$341.62
Max. Negotiated Rate	$7,087.50
Rate for Payer: Aetna Commercial	$5,386.50
Rate for Payer: Aetna Medicare Advantage	$4,252.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,614.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,614.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,614.62
Rate for Payer: Cigna Commercial	$7,087.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,430.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,118.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,126.25
Rate for Payer: UnitedHealthcare Community & State	$341.62
Rate for Payer: Wellpoint Medicaid Managed Care	$375.64

Know your out-of-pocket cost for care.

All Charges