Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT PROTEGE GPS 12x30x80

Facility

$4,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270644088
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 GPS 12X40X80

Facility

$4,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270636998N
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 GPS 12X40X80

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270636998C
Hospital Revenue Code	278
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

STENT PROTEGE GPS 12X40X80

Facility

$4,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270636998N
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 GPS 12X40X80

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270636998C
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT PROTEGE GPS 12X60X80

Facility

$4,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270636999N
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 GPS 12X60X80

Facility

$4,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270636999N
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 GPS 12X60X80

Facility

$6,624.80

Service Code	HCPCS C1876
Hospital Charge Code	270636999C
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 GPS 12X60X80

Facility

$6,624.80

Service Code	HCPCS C1876
Hospital Charge Code	270636999C
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 GPS 12x80x80

Facility

$4,875.00

Hospital Charge Code	270643433
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 GPS 12x80x80

Facility

$4,875.00

Hospital Charge Code	270643433
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 GPS 14X30X120

Facility

$4,875.00

Hospital Charge Code	270643090C
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 GPS 14X30X120

Facility

$4,875.00

Hospital Charge Code	270643090C
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 GPS 14X30X80

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270644432N
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT PROTEGE GPS 14X30X80

Facility

$6,624.80

Service Code	HCPCS C1876
Hospital Charge Code	270644432C
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 GPS 14X30X80

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270644432N
Hospital Revenue Code	278
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

STENT PROTEGE GPS 14X30X80

Facility

$6,624.80

Service Code	HCPCS C1876
Hospital Charge Code	270644432C
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 GPS 14x40x80

Facility

$6,850.00

Service Code	HCPCS C1876
Hospital Charge Code	270637000
Hospital Revenue Code	278
Min. Negotiated Rate	$165.09
Max. Negotiated Rate	$3,425.00
Rate for Payer: Aetna Commercial	$2,603.00
Rate for Payer: Aetna Medicare Advantage	$2,055.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,746.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,746.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,746.75
Rate for Payer: Cigna Commercial	$3,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,657.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,507.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,027.50
Rate for Payer: UnitedHealthcare Community & State	$165.09
Rate for Payer: Wellpoint Medicaid Managed Care	$181.53

STENT PROTEGE GPS 14x40x80

Facility

$6,850.00

Service Code	HCPCS C1876
Hospital Charge Code	270637000C
Hospital Revenue Code	278
Min. Negotiated Rate	$165.09
Max. Negotiated Rate	$3,425.00
Rate for Payer: Aetna Commercial	$2,603.00
Rate for Payer: Aetna Medicare Advantage	$2,055.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,746.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,746.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,746.75
Rate for Payer: Cigna Commercial	$3,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,657.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,507.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,027.50
Rate for Payer: UnitedHealthcare Community & State	$165.09
Rate for Payer: Wellpoint Medicaid Managed Care	$181.53

STENT PROTEGE GPS 14x40x80

Facility

$6,850.00

Service Code	HCPCS C1876
Hospital Charge Code	270637000C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,027.50
Max. Negotiated Rate	$1,657.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,370.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,657.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,507.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,027.50

STENT PROTEGE GPS 14x40x80

Facility

$6,850.00

Service Code	HCPCS C1876
Hospital Charge Code	270637000
Hospital Revenue Code	278
Min. Negotiated Rate	$1,027.50
Max. Negotiated Rate	$1,657.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,370.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,657.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,507.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,027.50

STENT PROTEGE GPS 14x40x80

Facility

$6,850.00

Service Code	HCPCS C1876
Hospital Charge Code	270637000S
Hospital Revenue Code	278
Min. Negotiated Rate	$165.09
Max. Negotiated Rate	$3,425.00
Rate for Payer: Aetna Commercial	$2,603.00
Rate for Payer: Aetna Medicare Advantage	$2,055.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,746.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,746.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,746.75
Rate for Payer: Cigna Commercial	$3,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,657.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,507.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,027.50
Rate for Payer: UnitedHealthcare Community & State	$165.09
Rate for Payer: Wellpoint Medicaid Managed Care	$181.53

STENT PROTEGE GPS 14x40x80

Facility

$6,850.00

Service Code	HCPCS C1876
Hospital Charge Code	270637000N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,027.50
Max. Negotiated Rate	$1,657.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,370.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,657.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,507.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,027.50

STENT PROTEGE GPS 14x40x80

Facility

$6,850.00

Service Code	HCPCS C1876
Hospital Charge Code	270637000S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,027.50
Max. Negotiated Rate	$1,657.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,370.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,657.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,507.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,027.50

STENT PROTEGE GPS 14x40x80

Facility

$6,850.00

Service Code	HCPCS C1876
Hospital Charge Code	270637000N
Hospital Revenue Code	278
Min. Negotiated Rate	$165.09
Max. Negotiated Rate	$3,425.00
Rate for Payer: Aetna Commercial	$2,603.00
Rate for Payer: Aetna Medicare Advantage	$2,055.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,746.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,746.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,746.75
Rate for Payer: Cigna Commercial	$3,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,657.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,507.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,027.50
Rate for Payer: UnitedHealthcare Community & State	$165.09
Rate for Payer: Wellpoint Medicaid Managed Care	$181.53

Know your out-of-pocket cost for care.

All Charges