Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT PROTEGE EVERFLEX 6x20

Facility

$4,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270643434S
Hospital Revenue Code	278
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$1,179.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,072.50
Rate for Payer: Qualcare PPO/HMO/WC	$731.25

STENT PROTEGE EVERFLEX 6x20

Facility

$4,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270643434S
Hospital Revenue Code	278
Min. Negotiated Rate	$117.49
Max. Negotiated Rate	$2,437.50
Rate for Payer: Aetna Commercial	$1,852.50
Rate for Payer: Aetna Medicare Advantage	$1,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,243.12
Rate for Payer: Cigna Commercial	$2,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,072.50
Rate for Payer: Qualcare PPO/HMO/WC	$731.25
Rate for Payer: UnitedHealthcare Community & State	$117.49
Rate for Payer: Wellpoint Medicaid Managed Care	$129.19

STENT PROTEGE EVERFLEX 6X30

Facility

$4,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270643435N
Hospital Revenue Code	278
Min. Negotiated Rate	$117.49
Max. Negotiated Rate	$2,437.50
Rate for Payer: Aetna Commercial	$1,852.50
Rate for Payer: Aetna Medicare Advantage	$1,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,243.12
Rate for Payer: Cigna Commercial	$2,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,072.50
Rate for Payer: Qualcare PPO/HMO/WC	$731.25
Rate for Payer: UnitedHealthcare Community & State	$117.49
Rate for Payer: Wellpoint Medicaid Managed Care	$129.19

STENT PROTEGE EVERFLEX 6X30

Facility

$6,624.80

Service Code	HCPCS C1876
Hospital Charge Code	270643435C
Hospital Revenue Code	278
Min. Negotiated Rate	$993.72
Max. Negotiated Rate	$1,603.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,324.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,603.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,457.46
Rate for Payer: Qualcare PPO/HMO/WC	$993.72

STENT PROTEGE EVERFLEX 6X30

Facility

$6,624.80

Service Code	HCPCS C1876
Hospital Charge Code	270643435C
Hospital Revenue Code	278
Min. Negotiated Rate	$159.66
Max. Negotiated Rate	$3,312.40
Rate for Payer: Aetna Commercial	$2,517.42
Rate for Payer: Aetna Medicare Advantage	$1,987.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,689.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,689.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,324.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,689.32
Rate for Payer: Cigna Commercial	$3,312.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,603.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,457.46
Rate for Payer: Qualcare PPO/HMO/WC	$993.72
Rate for Payer: UnitedHealthcare Community & State	$159.66
Rate for Payer: Wellpoint Medicaid Managed Care	$175.56

STENT PROTEGE EVERFLEX 6X30

Facility

$4,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270643435N
Hospital Revenue Code	278
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$1,179.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,072.50
Rate for Payer: Qualcare PPO/HMO/WC	$731.25

STENT PROTEGE EVERFLEX 7X100

Facility

$5,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270638088N
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

STENT PROTEGE EVERFLEX 7X100

Facility

$5,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270638088N
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

STENT PROTEGE EVERFLEX 7X100

Facility

$7,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270638088C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

STENT PROTEGE EVERFLEX 7X100

Facility

$7,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270638088C
Hospital Revenue Code	278
Min. Negotiated Rate	$186.78
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,945.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50
Rate for Payer: UnitedHealthcare Community & State	$186.78
Rate for Payer: Wellpoint Medicaid Managed Care	$205.38

STENT PROTEGE EVERFLEX 7X120

Facility

$5,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270638403N
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

STENT PROTEGE EVERFLEX 7X120

Facility

$5,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270638403C
Hospital Revenue Code	278
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

STENT PROTEGE EVERFLEX 7X120

Facility

$5,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270638403C
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

STENT PROTEGE EVERFLEX 7X120

Facility

$5,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270638403N
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

STENT PROTEGE EVERFLEX 8X100

Facility

$5,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270637008C
Hospital Revenue Code	278
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

STENT PROTEGE EVERFLEX 8X100

Facility

$5,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270637008N
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

STENT PROTEGE EVERFLEX 8X100

Facility

$5,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270637008N
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

STENT PROTEGE EVERFLEX 8X100

Facility

$5,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270637008C
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

STENT PROTEGE EVERFLEX 8x150

Facility

$5,500.00

Service Code	HCPCS C2617
Hospital Charge Code	270637009
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

STENT PROTEGE EVERFLEX 8x150

Facility

$1,815.00

Service Code	HCPCS C2617
Hospital Charge Code	270637009N
Hospital Revenue Code	278
Min. Negotiated Rate	$272.25
Max. Negotiated Rate	$439.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$363.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$439.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$399.30
Rate for Payer: Qualcare PPO/HMO/WC	$272.25

STENT PROTEGE EVERFLEX 8x150

Facility

$5,500.00

Service Code	HCPCS C2617
Hospital Charge Code	270637009
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

STENT PROTEGE EVERFLEX 8x150

Facility

$1,815.00

Service Code	HCPCS C2617
Hospital Charge Code	270637009S
Hospital Revenue Code	278
Min. Negotiated Rate	$272.25
Max. Negotiated Rate	$439.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$363.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$439.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$399.30
Rate for Payer: Qualcare PPO/HMO/WC	$272.25

STENT PROTEGE EVERFLEX 8x150

Facility

$1,815.00

Service Code	HCPCS C2617
Hospital Charge Code	270637009S
Hospital Revenue Code	278
Min. Negotiated Rate	$43.74
Max. Negotiated Rate	$907.50
Rate for Payer: Aetna Commercial	$689.70
Rate for Payer: Aetna Medicare Advantage	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$462.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$462.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$462.82
Rate for Payer: Cigna Commercial	$907.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$439.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$399.30
Rate for Payer: Qualcare PPO/HMO/WC	$272.25
Rate for Payer: UnitedHealthcare Community & State	$43.74
Rate for Payer: Wellpoint Medicaid Managed Care	$48.10

STENT PROTEGE EVERFLEX 8x150

Facility

$1,815.00

Service Code	HCPCS C2617
Hospital Charge Code	270637009N
Hospital Revenue Code	278
Min. Negotiated Rate	$43.74
Max. Negotiated Rate	$907.50
Rate for Payer: Aetna Commercial	$689.70
Rate for Payer: Aetna Medicare Advantage	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$462.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$462.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$462.82
Rate for Payer: Cigna Commercial	$907.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$439.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$399.30
Rate for Payer: Qualcare PPO/HMO/WC	$272.25
Rate for Payer: UnitedHealthcare Community & State	$43.74
Rate for Payer: Wellpoint Medicaid Managed Care	$48.10

STENT PROTEGE EVERFLEX 8X30

Facility

$1,395.00

Service Code	HCPCS C1876
Hospital Charge Code	270644087S
Hospital Revenue Code	278
Min. Negotiated Rate	$209.25
Max. Negotiated Rate	$337.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$279.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$306.90
Rate for Payer: Qualcare PPO/HMO/WC	$209.25

Know your out-of-pocket cost for care.

All Charges