Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT WALLFLEX BILIARY 10X80

Facility

$12,999.50

Service Code	HCPCS C1876
Hospital Charge Code	270646676C
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

$14,175.00

Service Code	HCPCS C1876
Hospital Charge Code	270646676N
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 10x80mm

Facility

$17,250.00

Hospital Charge Code	270642705
Hospital Revenue Code	278
Min. Negotiated Rate	$2,587.50
Max. Negotiated Rate	$4,174.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,795.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,587.50

STENT WALLFLEX BILIARY 10x80mm

Facility

$17,250.00

Hospital Charge Code	270642705
Hospital Revenue Code	278
Min. Negotiated Rate	$415.73
Max. Negotiated Rate	$8,625.00
Rate for Payer: Aetna Commercial	$6,555.00
Rate for Payer: Aetna Medicare Advantage	$5,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,398.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,398.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,398.75
Rate for Payer: Cigna Commercial	$8,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,795.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,587.50
Rate for Payer: UnitedHealthcare Community & State	$415.73
Rate for Payer: Wellpoint Medicaid Managed Care	$457.12

STENT WALLFLEX BILIARY 10x80MM

Facility

$12,995.00

Hospital Charge Code	270646676
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 BILIARY 10x80MM

Facility

$12,995.00

Hospital Charge Code	270646676
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 BILIARY 8x60

Facility

$14,175.00

Service Code	HCPCS C1876
Hospital Charge Code	270645387
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 8x60

Facility

$14,175.00

Service Code	HCPCS C1876
Hospital Charge Code	270645387
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 8X60

Facility

$14,175.00

Hospital Charge Code	270644971
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 8X60

Facility

$14,175.00

Hospital Charge Code	270644971
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 8x80

Facility

$12,999.50

Service Code	HCPCS C1874
Hospital Charge Code	270677876
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 8x80

Facility

$12,999.50

Service Code	HCPCS C1874
Hospital Charge Code	270677876
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 COLON 22X9CM

Facility

$12,975.00

Service Code	HCPCS C1876
Hospital Charge Code	270643472
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 COLON 22X9CM

Facility

$12,975.00

Service Code	HCPCS C1876
Hospital Charge Code	270643472
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 COLON 25X9CM

Facility

$12,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270662149
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 COLON 25X9CM

Facility

$12,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270662149
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 DUODENAL

Facility

$12,300.35

Service Code	HCPCS C1876
Hospital Charge Code	270648010
Hospital Revenue Code	278
Min. Negotiated Rate	$296.44
Max. Negotiated Rate	$6,150.18
Rate for Payer: Aetna Commercial	$4,674.13
Rate for Payer: Aetna Medicare Advantage	$3,690.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,136.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,136.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,460.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,136.59
Rate for Payer: Cigna Commercial	$6,150.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,976.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,706.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,845.05
Rate for Payer: UnitedHealthcare Community & State	$296.44
Rate for Payer: Wellpoint Medicaid Managed Care	$325.96

STENT WALLFLEX DUODENAL

Facility

$12,300.35

Service Code	HCPCS C1876
Hospital Charge Code	270648010
Hospital Revenue Code	278
Min. Negotiated Rate	$1,845.05
Max. Negotiated Rate	$2,976.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,460.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,976.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,706.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,845.05

STENT--WALLFLEX ESOPHAGEAL18MM

Facility

$11,995.00

Service Code	HCPCS C1874
Hospital Charge Code	270680058
Hospital Revenue Code	278
Min. Negotiated Rate	$289.08
Max. Negotiated Rate	$5,997.50
Rate for Payer: Aetna Commercial	$4,558.10
Rate for Payer: Aetna Medicare Advantage	$3,598.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,058.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,058.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,399.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,058.72
Rate for Payer: Cigna Commercial	$5,997.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,902.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,638.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,799.25
Rate for Payer: UnitedHealthcare Community & State	$289.08
Rate for Payer: Wellpoint Medicaid Managed Care	$317.87

STENT--WALLFLEX ESOPHAGEAL18MM

Facility

$11,995.00

Service Code	HCPCS C1874
Hospital Charge Code	270680058
Hospital Revenue Code	278
Min. Negotiated Rate	$1,799.25
Max. Negotiated Rate	$2,902.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,399.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,902.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,638.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,799.25

STENT WALLFX 27/22X12 230 6512

Facility

$12,975.00

Hospital Charge Code	270644083
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 WALLFX 27/22X12 230 6512

Facility

$12,975.00

Hospital Charge Code	270644083
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 WALLGRAFT 10x50

Facility

$10,265.00

Hospital Charge Code	270623517
Hospital Revenue Code	278
Min. Negotiated Rate	$1,539.75
Max. Negotiated Rate	$2,484.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,053.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,484.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,258.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,539.75

STENT WALLGRAFT 10x50

Facility

$10,265.00

Hospital Charge Code	270623517
Hospital Revenue Code	278
Min. Negotiated Rate	$247.39
Max. Negotiated Rate	$5,132.50
Rate for Payer: Aetna Commercial	$3,900.70
Rate for Payer: Aetna Medicare Advantage	$3,079.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,617.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,617.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,053.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,617.57
Rate for Payer: Cigna Commercial	$5,132.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,484.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,258.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,539.75
Rate for Payer: UnitedHealthcare Community & State	$247.39
Rate for Payer: Wellpoint Medicaid Managed Care	$272.02

STENT WALLGRAFT 12x50

Facility

$10,265.00

Hospital Charge Code	270623518
Hospital Revenue Code	278
Min. Negotiated Rate	$247.39
Max. Negotiated Rate	$5,132.50
Rate for Payer: Aetna Commercial	$3,900.70
Rate for Payer: Aetna Medicare Advantage	$3,079.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,617.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,617.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,053.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,617.57
Rate for Payer: Cigna Commercial	$5,132.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,484.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,258.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,539.75
Rate for Payer: UnitedHealthcare Community & State	$247.39
Rate for Payer: Wellpoint Medicaid Managed Care	$272.02

Know your out-of-pocket cost for care.

All Charges