Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT OVATION IX 14 X100 MM

Facility

$28,495.00

Service Code	HCPCS C1874
Hospital Charge Code	270689530
Hospital Revenue Code	278
Min. Negotiated Rate	$4,274.25
Max. Negotiated Rate	$6,895.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,895.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,268.90
Rate for Payer: Qualcare PPO/HMO/WC	$4,274.25

STENT OVATION IX 18X 120 MM

Facility

$28,495.00

Service Code	HCPCS C1874
Hospital Charge Code	270691626
Hospital Revenue Code	278
Min. Negotiated Rate	$4,274.25
Max. Negotiated Rate	$6,895.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,895.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,268.90
Rate for Payer: Qualcare PPO/HMO/WC	$4,274.25

STENT OVATION IX 18X 120 MM

Facility

$28,495.00

Service Code	HCPCS C1874
Hospital Charge Code	270691626
Hospital Revenue Code	278
Min. Negotiated Rate	$686.73
Max. Negotiated Rate	$14,247.50
Rate for Payer: Aetna Commercial	$10,828.10
Rate for Payer: Aetna Medicare Advantage	$8,548.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,266.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,266.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,266.23
Rate for Payer: Cigna Commercial	$14,247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,895.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,268.90
Rate for Payer: Qualcare PPO/HMO/WC	$4,274.25
Rate for Payer: UnitedHealthcare Community & State	$686.73
Rate for Payer: Wellpoint Medicaid Managed Care	$755.12

STENT OVATION IX 22 X 100 MMST

Facility

$28,495.00

Service Code	HCPCS C1874
Hospital Charge Code	270689531
Hospital Revenue Code	278
Min. Negotiated Rate	$686.73
Max. Negotiated Rate	$14,247.50
Rate for Payer: Aetna Commercial	$10,828.10
Rate for Payer: Aetna Medicare Advantage	$8,548.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,266.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,266.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,266.23
Rate for Payer: Cigna Commercial	$14,247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,895.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,268.90
Rate for Payer: Qualcare PPO/HMO/WC	$4,274.25
Rate for Payer: UnitedHealthcare Community & State	$686.73
Rate for Payer: Wellpoint Medicaid Managed Care	$755.12

STENT OVATION IX 22 X 100 MMST

Facility

$28,495.00

Service Code	HCPCS C1874
Hospital Charge Code	270689531
Hospital Revenue Code	278
Min. Negotiated Rate	$4,274.25
Max. Negotiated Rate	$6,895.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,895.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,268.90
Rate for Payer: Qualcare PPO/HMO/WC	$4,274.25

STENT PACIFIC PLUS 6X120X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683560N
Hospital Revenue Code	278
Min. Negotiated Rate	$27.47
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$27.47
Rate for Payer: Wellpoint Medicaid Managed Care	$30.21

STENT PACIFIC PLUS 6X120X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683560
Hospital Revenue Code	278
Min. Negotiated Rate	$27.47
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$27.47
Rate for Payer: Wellpoint Medicaid Managed Care	$30.21

STENT PACIFIC PLUS 6X120X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683560
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

STENT PACIFIC PLUS 6X120X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683560N
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

STENT PACIFIC PLUS 6X20X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683559N
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

STENT PACIFIC PLUS 6X20X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683559N
Hospital Revenue Code	278
Min. Negotiated Rate	$27.47
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$27.47
Rate for Payer: Wellpoint Medicaid Managed Care	$30.21

STENT PACIFIC PLUS 6X20X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683559
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

STENT PACIFIC PLUS 6X20X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683559
Hospital Revenue Code	278
Min. Negotiated Rate	$27.47
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$27.47
Rate for Payer: Wellpoint Medicaid Managed Care	$30.21

STENT PACIFIC PLUS 6X40X180

Facility

$1,047.40

Service Code	HCPCS C1876
Hospital Charge Code	270683562
Hospital Revenue Code	278
Min. Negotiated Rate	$157.11
Max. Negotiated Rate	$253.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$230.43
Rate for Payer: Qualcare PPO/HMO/WC	$157.11

STENT PACIFIC PLUS 6X40X180

Facility

$1,047.40

Service Code	HCPCS C1876
Hospital Charge Code	270683562
Hospital Revenue Code	278
Min. Negotiated Rate	$25.24
Max. Negotiated Rate	$523.70
Rate for Payer: Aetna Commercial	$398.01
Rate for Payer: Aetna Medicare Advantage	$314.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.09
Rate for Payer: Cigna Commercial	$523.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$230.43
Rate for Payer: Qualcare PPO/HMO/WC	$157.11
Rate for Payer: UnitedHealthcare Community & State	$25.24
Rate for Payer: Wellpoint Medicaid Managed Care	$27.76

STENT PACIFIC PLUS 6X40X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683562N
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

STENT PACIFIC PLUS 6X40X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683562N
Hospital Revenue Code	278
Min. Negotiated Rate	$27.47
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$27.47
Rate for Payer: Wellpoint Medicaid Managed Care	$30.21

STENT PACIFIC PLUS 6X60X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683561
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

STENT PACIFIC PLUS 6X60X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683561
Hospital Revenue Code	278
Min. Negotiated Rate	$27.47
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$27.47
Rate for Payer: Wellpoint Medicaid Managed Care	$30.21

STENT PACIFIC PLUS 6X60X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683561N
Hospital Revenue Code	278
Min. Negotiated Rate	$27.47
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$27.47
Rate for Payer: Wellpoint Medicaid Managed Care	$30.21

STENT PACIFIC PLUS 6X60X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683561N
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

STENT PALMAZ XL 30MM P3110

Facility

$7,675.00

Hospital Charge Code	270641380
Hospital Revenue Code	278
Min. Negotiated Rate	$184.97
Max. Negotiated Rate	$3,837.50
Rate for Payer: Aetna Commercial	$2,916.50
Rate for Payer: Aetna Medicare Advantage	$2,302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,957.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,957.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,535.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,957.12
Rate for Payer: Cigna Commercial	$3,837.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,857.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,688.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,151.25
Rate for Payer: UnitedHealthcare Community & State	$184.97
Rate for Payer: Wellpoint Medicaid Managed Care	$203.39

STENT PALMAZ XL 30MM P3110

Facility

$7,675.00

Hospital Charge Code	270641380
Hospital Revenue Code	278
Min. Negotiated Rate	$1,151.25
Max. Negotiated Rate	$1,857.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,535.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,857.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,688.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,151.25

STENT PALMAZ XL 40MM

Facility

$6,925.00

Hospital Charge Code	270634569
Hospital Revenue Code	278
Min. Negotiated Rate	$1,038.75
Max. Negotiated Rate	$1,675.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,385.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,675.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,523.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,038.75

STENT PALMAZ XL 40MM

Facility

$6,925.00

Hospital Charge Code	270634569
Hospital Revenue Code	278
Min. Negotiated Rate	$166.89
Max. Negotiated Rate	$3,462.50
Rate for Payer: Aetna Commercial	$2,631.50
Rate for Payer: Aetna Medicare Advantage	$2,077.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,765.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,765.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,385.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,765.88
Rate for Payer: Cigna Commercial	$3,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,675.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,523.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,038.75
Rate for Payer: UnitedHealthcare Community & State	$166.89
Rate for Payer: Wellpoint Medicaid Managed Care	$183.51

Know your out-of-pocket cost for care.

All Charges