Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT VIABAHN 7MM X 29 MM

Facility

$16,680.00

Service Code	HCPCS C1876
Hospital Charge Code	270682404S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,502.00
Max. Negotiated Rate	$4,036.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,336.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,036.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,669.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,502.00

STENT VIABAHN 7MM X 29 MM

Facility

$16,680.00

Service Code	HCPCS C1876
Hospital Charge Code	270682404
Hospital Revenue Code	278
Min. Negotiated Rate	$2,502.00
Max. Negotiated Rate	$4,036.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,336.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,036.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,669.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,502.00

STENT VIABAHN 7MM X 29 MM

Facility

$16,680.00

Service Code	HCPCS C1876
Hospital Charge Code	270682404
Hospital Revenue Code	278
Min. Negotiated Rate	$401.99
Max. Negotiated Rate	$8,340.00
Rate for Payer: Aetna Commercial	$6,338.40
Rate for Payer: Aetna Medicare Advantage	$5,004.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,253.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,253.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,336.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,253.40
Rate for Payer: Cigna Commercial	$8,340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,036.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,669.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,502.00
Rate for Payer: UnitedHealthcare Community & State	$401.99
Rate for Payer: Wellpoint Medicaid Managed Care	$442.02

STENT VIABAHN 7MMx5CMx120CM

Facility

$14,710.00

Service Code	HCPCS C1876
Hospital Charge Code	270648640
Hospital Revenue Code	278
Min. Negotiated Rate	$2,206.50
Max. Negotiated Rate	$3,559.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,942.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,559.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,236.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,206.50

STENT VIABAHN 7MMx5CMx120CM

Facility

$14,710.00

Service Code	HCPCS C1876
Hospital Charge Code	270648640
Hospital Revenue Code	278
Min. Negotiated Rate	$354.51
Max. Negotiated Rate	$7,355.00
Rate for Payer: Aetna Commercial	$5,589.80
Rate for Payer: Aetna Medicare Advantage	$4,413.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,751.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,751.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,942.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,751.05
Rate for Payer: Cigna Commercial	$7,355.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,559.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,236.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,206.50
Rate for Payer: UnitedHealthcare Community & State	$354.51
Rate for Payer: Wellpoint Medicaid Managed Care	$389.81

STENT VIABAHN 7MMX5CMX120CM

Facility

$14,710.00

Service Code	HCPCS C1876
Hospital Charge Code	270648640S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,206.50
Max. Negotiated Rate	$3,559.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,942.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,559.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,236.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,206.50

STENT VIABAHN 7MMX5CMX120CM

Facility

$14,710.00

Service Code	HCPCS C1876
Hospital Charge Code	270648640S
Hospital Revenue Code	278
Min. Negotiated Rate	$354.51
Max. Negotiated Rate	$7,355.00
Rate for Payer: Aetna Commercial	$5,589.80
Rate for Payer: Aetna Medicare Advantage	$4,413.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,751.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,751.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,942.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,751.05
Rate for Payer: Cigna Commercial	$7,355.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,559.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,236.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,206.50
Rate for Payer: UnitedHealthcare Community & State	$354.51
Rate for Payer: Wellpoint Medicaid Managed Care	$389.81

STENT VIABAHN 8FR 7X15 120CM

Facility

$24,242.84

Hospital Charge Code	270639499C
Hospital Revenue Code	278
Min. Negotiated Rate	$3,636.43
Max. Negotiated Rate	$5,866.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,848.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,866.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,333.42
Rate for Payer: Qualcare PPO/HMO/WC	$3,636.43

STENT VIABAHN 8FR 7X15 120CM

Facility

$24,242.84

Hospital Charge Code	270639499C
Hospital Revenue Code	278
Min. Negotiated Rate	$584.25
Max. Negotiated Rate	$12,121.42
Rate for Payer: Aetna Commercial	$9,212.28
Rate for Payer: Aetna Medicare Advantage	$7,272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,181.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,181.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,848.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,181.92
Rate for Payer: Cigna Commercial	$12,121.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,866.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,333.42
Rate for Payer: Qualcare PPO/HMO/WC	$3,636.43
Rate for Payer: UnitedHealthcare Community & State	$584.25
Rate for Payer: Wellpoint Medicaid Managed Care	$642.44

STENT VIABAHN 8FR 8x15 120cm

Facility

$18,975.00

Hospital Charge Code	270669521
Hospital Revenue Code	278
Min. Negotiated Rate	$457.30
Max. Negotiated Rate	$9,487.50
Rate for Payer: Aetna Commercial	$7,210.50
Rate for Payer: Aetna Medicare Advantage	$5,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,838.62
Rate for Payer: Cigna Commercial	$9,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,174.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25
Rate for Payer: UnitedHealthcare Community & State	$457.30
Rate for Payer: Wellpoint Medicaid Managed Care	$502.84

STENT VIABAHN 8FR 8x15 120cm

Facility

$18,975.00

Hospital Charge Code	270669521
Hospital Revenue Code	278
Min. Negotiated Rate	$2,846.25
Max. Negotiated Rate	$4,591.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,174.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25

STENT VIABAHN 8FR VBH080502

Facility

$24,242.84

Hospital Charge Code	270644101C
Hospital Revenue Code	278
Min. Negotiated Rate	$584.25
Max. Negotiated Rate	$12,121.42
Rate for Payer: Aetna Commercial	$9,212.28
Rate for Payer: Aetna Medicare Advantage	$7,272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,181.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,181.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,848.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,181.92
Rate for Payer: Cigna Commercial	$12,121.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,866.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,333.42
Rate for Payer: Qualcare PPO/HMO/WC	$3,636.43
Rate for Payer: UnitedHealthcare Community & State	$584.25
Rate for Payer: Wellpoint Medicaid Managed Care	$642.44

STENT VIABAHN 8FR VBH080502

Facility

$24,242.84

Hospital Charge Code	270644101C
Hospital Revenue Code	278
Min. Negotiated Rate	$3,636.43
Max. Negotiated Rate	$5,866.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,848.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,866.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,333.42
Rate for Payer: Qualcare PPO/HMO/WC	$3,636.43

STENT VIABAHN 8 MMx135MM

Facility

$17,095.00

Service Code	HCPCS C1876
Hospital Charge Code	270686404
Hospital Revenue Code	278
Min. Negotiated Rate	$2,564.25
Max. Negotiated Rate	$4,136.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,419.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,136.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,760.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,564.25

STENT VIABAHN 8 MMx135MM

Facility

$17,095.00

Service Code	HCPCS C1876
Hospital Charge Code	270686404O
Hospital Revenue Code	278
Min. Negotiated Rate	$2,564.25
Max. Negotiated Rate	$4,136.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,419.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,136.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,760.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,564.25

STENT VIABAHN 8 MMx135MM

Facility

$17,095.00

Service Code	HCPCS C1876
Hospital Charge Code	270686404
Hospital Revenue Code	278
Min. Negotiated Rate	$411.99
Max. Negotiated Rate	$8,547.50
Rate for Payer: Aetna Commercial	$6,496.10
Rate for Payer: Aetna Medicare Advantage	$5,128.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,359.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,359.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,419.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,359.23
Rate for Payer: Cigna Commercial	$8,547.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,136.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,760.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,564.25
Rate for Payer: UnitedHealthcare Community & State	$411.99
Rate for Payer: Wellpoint Medicaid Managed Care	$453.02

STENT VIABAHN 8 MMx135MM

Facility

$17,095.00

Service Code	HCPCS C1876
Hospital Charge Code	270686404O
Hospital Revenue Code	278
Min. Negotiated Rate	$411.99
Max. Negotiated Rate	$8,547.50
Rate for Payer: Aetna Commercial	$6,496.10
Rate for Payer: Aetna Medicare Advantage	$5,128.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,359.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,359.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,419.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,359.23
Rate for Payer: Cigna Commercial	$8,547.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,136.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,760.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,564.25
Rate for Payer: UnitedHealthcare Community & State	$411.99
Rate for Payer: Wellpoint Medicaid Managed Care	$453.02

STENT VIABAHN 8 MMx59MM

Facility

$18,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686405
Hospital Revenue Code	278
Min. Negotiated Rate	$2,812.50
Max. Negotiated Rate	$4,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50

STENT VIABAHN 8 MMx59MM

Facility

$18,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686405
Hospital Revenue Code	278
Min. Negotiated Rate	$451.88
Max. Negotiated Rate	$9,375.00
Rate for Payer: Aetna Commercial	$7,125.00
Rate for Payer: Aetna Medicare Advantage	$5,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,781.25
Rate for Payer: Cigna Commercial	$9,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50
Rate for Payer: UnitedHealthcare Community & State	$451.88
Rate for Payer: Wellpoint Medicaid Managed Care	$496.88

STENT VIABAHN 8 MMx59MM

Facility

$18,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686405O
Hospital Revenue Code	278
Min. Negotiated Rate	$451.88
Max. Negotiated Rate	$9,375.00
Rate for Payer: Aetna Commercial	$7,125.00
Rate for Payer: Aetna Medicare Advantage	$5,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,781.25
Rate for Payer: Cigna Commercial	$9,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50
Rate for Payer: UnitedHealthcare Community & State	$451.88
Rate for Payer: Wellpoint Medicaid Managed Care	$496.88

STENT VIABAHN 8 MMx59MM

Facility

$18,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686405O
Hospital Revenue Code	278
Min. Negotiated Rate	$2,812.50
Max. Negotiated Rate	$4,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50

STENT VIABAHN 8mmX59mmx135mm

Facility

$16,680.00

Service Code	HCPCS C1876
Hospital Charge Code	270679678
Hospital Revenue Code	278
Min. Negotiated Rate	$2,502.00
Max. Negotiated Rate	$4,036.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,336.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,036.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,669.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,502.00

STENT VIABAHN 8mmX59mmx135mm

Facility

$16,680.00

Service Code	HCPCS C1876
Hospital Charge Code	270679678
Hospital Revenue Code	278
Min. Negotiated Rate	$401.99
Max. Negotiated Rate	$8,340.00
Rate for Payer: Aetna Commercial	$6,338.40
Rate for Payer: Aetna Medicare Advantage	$5,004.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,253.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,253.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,336.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,253.40
Rate for Payer: Cigna Commercial	$8,340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,036.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,669.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,502.00
Rate for Payer: UnitedHealthcare Community & State	$401.99
Rate for Payer: Wellpoint Medicaid Managed Care	$442.02

STENT VIABAHN 8MMX59MMx135MM

Facility

$16,275.00

Service Code	HCPCS C1876
Hospital Charge Code	270679678N
Hospital Revenue Code	278
Min. Negotiated Rate	$392.23
Max. Negotiated Rate	$8,137.50
Rate for Payer: Aetna Commercial	$6,184.50
Rate for Payer: Aetna Medicare Advantage	$4,882.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,150.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,150.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,150.12
Rate for Payer: Cigna Commercial	$8,137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,938.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,580.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,441.25
Rate for Payer: UnitedHealthcare Community & State	$392.23
Rate for Payer: Wellpoint Medicaid Managed Care	$431.29

STENT VIABAHN 8MMX59MMx135MM

Facility

$16,275.00

Service Code	HCPCS C1876
Hospital Charge Code	270679678S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,441.25
Max. Negotiated Rate	$3,938.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,938.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,580.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,441.25

Know your out-of-pocket cost for care.

All Charges