Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

WALLSTENT 16/40 10FR 100cm

Facility

$5,250.00

Hospital Charge Code	270627282
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

WALLSTENT 16/40 10FR 100cm

Facility

$5,250.00

Hospital Charge Code	270627282
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

WALL STENT 16X 90X 75 MM

Facility

$10,398.10

Service Code	HCPCS C1876
Hospital Charge Code	270684832N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,559.71
Max. Negotiated Rate	$2,516.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,079.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,516.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,287.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,559.71

WALL STENT 16X 90X 75 MM

Facility

$10,398.10

Service Code	HCPCS C1876
Hospital Charge Code	270684832
Hospital Revenue Code	278
Min. Negotiated Rate	$1,559.71
Max. Negotiated Rate	$2,516.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,079.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,516.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,287.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,559.71

WALL STENT 16X 90X 75 MM

Facility

$10,398.10

Service Code	HCPCS C1876
Hospital Charge Code	270684832
Hospital Revenue Code	278
Min. Negotiated Rate	$250.59
Max. Negotiated Rate	$5,199.05
Rate for Payer: Aetna Commercial	$3,951.28
Rate for Payer: Aetna Medicare Advantage	$3,119.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,651.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,651.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,079.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,651.52
Rate for Payer: Cigna Commercial	$5,199.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,516.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,287.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,559.71
Rate for Payer: UnitedHealthcare Community & State	$250.59
Rate for Payer: Wellpoint Medicaid Managed Care	$275.55

WALL STENT 16X 90X 75 MM

Facility

$10,398.10

Service Code	HCPCS C1876
Hospital Charge Code	270684832N
Hospital Revenue Code	278
Min. Negotiated Rate	$250.59
Max. Negotiated Rate	$5,199.05
Rate for Payer: Aetna Commercial	$3,951.28
Rate for Payer: Aetna Medicare Advantage	$3,119.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,651.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,651.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,079.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,651.52
Rate for Payer: Cigna Commercial	$5,199.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,516.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,287.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,559.71
Rate for Payer: UnitedHealthcare Community & State	$250.59
Rate for Payer: Wellpoint Medicaid Managed Care	$275.55

WALLSTENT 20X 80X 75

Facility

$10,383.10

Service Code	HCPCS C1876
Hospital Charge Code	270684833
Hospital Revenue Code	278
Min. Negotiated Rate	$250.23
Max. Negotiated Rate	$5,191.55
Rate for Payer: Aetna Commercial	$3,945.58
Rate for Payer: Aetna Medicare Advantage	$3,114.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,647.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,647.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,076.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,647.69
Rate for Payer: Cigna Commercial	$5,191.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,512.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,284.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,557.46
Rate for Payer: UnitedHealthcare Community & State	$250.23
Rate for Payer: Wellpoint Medicaid Managed Care	$275.15

WALLSTENT 20X 80X 75

Facility

$10,383.10

Service Code	HCPCS C1876
Hospital Charge Code	270684833
Hospital Revenue Code	278
Min. Negotiated Rate	$1,557.46
Max. Negotiated Rate	$2,512.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,076.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,512.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,284.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,557.46

WALLSTENT 20X 80X 75

Facility

$10,383.10

Service Code	HCPCS C1876
Hospital Charge Code	270684833N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,557.46
Max. Negotiated Rate	$2,512.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,076.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,512.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,284.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,557.46

WALLSTENT 20X 80X 75

Facility

$10,383.10

Service Code	HCPCS C1876
Hospital Charge Code	270684833N
Hospital Revenue Code	278
Min. Negotiated Rate	$250.23
Max. Negotiated Rate	$5,191.55
Rate for Payer: Aetna Commercial	$3,945.58
Rate for Payer: Aetna Medicare Advantage	$3,114.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,647.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,647.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,076.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,647.69
Rate for Payer: Cigna Commercial	$5,191.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,512.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,284.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,557.46
Rate for Payer: UnitedHealthcare Community & State	$250.23
Rate for Payer: Wellpoint Medicaid Managed Care	$275.15

WALLSTENT 22/45 11FR 100 40451

Facility

$5,726.90

Hospital Charge Code	270635129
Hospital Revenue Code	278
Min. Negotiated Rate	$138.02
Max. Negotiated Rate	$2,863.45
Rate for Payer: Aetna Commercial	$2,176.22
Rate for Payer: Aetna Medicare Advantage	$1,718.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,460.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,460.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,145.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,460.36
Rate for Payer: Cigna Commercial	$2,863.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,385.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,259.92
Rate for Payer: Qualcare PPO/HMO/WC	$859.03
Rate for Payer: UnitedHealthcare Community & State	$138.02
Rate for Payer: Wellpoint Medicaid Managed Care	$151.76

WALLSTENT 22/45 11FR 100 40451

Facility

$5,773.00

Hospital Charge Code	270635129V
Hospital Revenue Code	278
Min. Negotiated Rate	$865.95
Max. Negotiated Rate	$1,397.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,154.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,397.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,270.06
Rate for Payer: Qualcare PPO/HMO/WC	$865.95

WALLSTENT 22/45 11FR 100 40451

Facility

$5,773.00

Hospital Charge Code	270635129V
Hospital Revenue Code	278
Min. Negotiated Rate	$139.13
Max. Negotiated Rate	$2,886.50
Rate for Payer: Aetna Commercial	$2,193.74
Rate for Payer: Aetna Medicare Advantage	$1,731.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,472.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,472.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,154.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,472.12
Rate for Payer: Cigna Commercial	$2,886.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,397.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,270.06
Rate for Payer: Qualcare PPO/HMO/WC	$865.95
Rate for Payer: UnitedHealthcare Community & State	$139.13
Rate for Payer: Wellpoint Medicaid Managed Care	$152.98

WALLSTENT 22/45 11FR 100 40451

Facility

$5,726.90

Hospital Charge Code	270635129
Hospital Revenue Code	278
Min. Negotiated Rate	$859.03
Max. Negotiated Rate	$1,385.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,145.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,385.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,259.92
Rate for Payer: Qualcare PPO/HMO/WC	$859.03

WALLSTENT 22/70 11FR 100 40452

Facility

$8,743.15

Hospital Charge Code	270635130
Hospital Revenue Code	278
Min. Negotiated Rate	$1,311.47
Max. Negotiated Rate	$2,115.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,748.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,115.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,923.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,311.47

WALLSTENT 22/70 11FR 100 40452

Facility

$8,743.15

Hospital Charge Code	270635130
Hospital Revenue Code	278
Min. Negotiated Rate	$210.71
Max. Negotiated Rate	$4,371.57
Rate for Payer: Aetna Commercial	$3,322.40
Rate for Payer: Aetna Medicare Advantage	$2,622.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,748.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,229.50
Rate for Payer: Cigna Commercial	$4,371.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,115.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,923.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,311.47
Rate for Payer: UnitedHealthcare Community & State	$210.71
Rate for Payer: Wellpoint Medicaid Managed Care	$231.69

WALLSTENT 22/70 11FR 100 40452

Facility

$8,813.60

Hospital Charge Code	270635130V
Hospital Revenue Code	278
Min. Negotiated Rate	$212.41
Max. Negotiated Rate	$4,406.80
Rate for Payer: Aetna Commercial	$3,349.17
Rate for Payer: Aetna Medicare Advantage	$2,644.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,247.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,247.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,762.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,247.47
Rate for Payer: Cigna Commercial	$4,406.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,132.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,938.99
Rate for Payer: Qualcare PPO/HMO/WC	$1,322.04
Rate for Payer: UnitedHealthcare Community & State	$212.41
Rate for Payer: Wellpoint Medicaid Managed Care	$233.56

WALLSTENT 22/70 11FR 100 40452

Facility

$8,813.60

Hospital Charge Code	270635130V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,322.04
Max. Negotiated Rate	$2,132.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,762.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,132.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,938.99
Rate for Payer: Qualcare PPO/HMO/WC	$1,322.04

WALLSTENT 9FR 16x60 75CM

Facility

$5,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270676562
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

WALLSTENT 9FR 16x60 75CM

Facility

$5,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270676562
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

WALLSTENT BILIARY RX 10FR 10MM

Facility

$7,000.00

Hospital Charge Code	270636842
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

WALLSTENT BILIARY RX 10FR 10MM

Facility

$7,000.00

Hospital Charge Code	270636842
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

WALLSTENT MONORAIL 10x24 71840

Facility

$7,757.50

Hospital Charge Code	270631408
Hospital Revenue Code	278
Min. Negotiated Rate	$186.96
Max. Negotiated Rate	$3,878.75
Rate for Payer: Aetna Commercial	$2,947.85
Rate for Payer: Aetna Medicare Advantage	$2,327.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,978.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,978.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,551.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,978.16
Rate for Payer: Cigna Commercial	$3,878.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,877.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,706.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,163.62
Rate for Payer: UnitedHealthcare Community & State	$186.96
Rate for Payer: Wellpoint Medicaid Managed Care	$205.57

WALLSTENT MONORAIL 10x24 71840

Facility

$7,757.50

Hospital Charge Code	270631408V
Hospital Revenue Code	278
Min. Negotiated Rate	$186.96
Max. Negotiated Rate	$3,878.75
Rate for Payer: Aetna Commercial	$2,947.85
Rate for Payer: Aetna Medicare Advantage	$2,327.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,978.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,978.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,551.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,978.16
Rate for Payer: Cigna Commercial	$3,878.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,877.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,706.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,163.62
Rate for Payer: UnitedHealthcare Community & State	$186.96
Rate for Payer: Wellpoint Medicaid Managed Care	$205.57

WALLSTENT MONORAIL 10x24 71840

Facility

$7,757.50

Hospital Charge Code	270631408V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,163.62
Max. Negotiated Rate	$1,877.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,551.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,877.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,706.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,163.62

Know your out-of-pocket cost for care.

All Charges