Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT VIABAHN 8MMX59MMx135MM

Facility

$16,275.00

Service Code	HCPCS C1876
Hospital Charge Code	270679678S
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	270679678N
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

STENT VIABAHN 8x15cm

Facility

$18,975.00

Hospital Charge Code	270671133
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 8x15cm

Facility

$18,975.00

Hospital Charge Code	270671133
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 8x39MM 135CM

Facility

$19,235.00

Service Code	HCPCS C1874
Hospital Charge Code	270699839S
Hospital Revenue Code	278
Min. Negotiated Rate	$463.56
Max. Negotiated Rate	$9,617.50
Rate for Payer: Aetna Commercial	$7,309.30
Rate for Payer: Aetna Medicare Advantage	$5,770.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,904.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,904.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,904.93
Rate for Payer: Cigna Commercial	$9,617.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,654.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,231.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,885.25
Rate for Payer: UnitedHealthcare Community & State	$463.56
Rate for Payer: Wellpoint Medicaid Managed Care	$509.73

STENT VIABAHN 8x39MM 135CM

Facility

$19,235.00

Service Code	HCPCS C1874
Hospital Charge Code	270699839S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,885.25
Max. Negotiated Rate	$4,654.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,847.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,654.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,231.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,885.25

STENT VIABAHN 8X5 VBA080502

Facility

$24,242.84

Hospital Charge Code	270633179
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 8X5 VBA080502

Facility

$24,242.84

Hospital Charge Code	270633179
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 8x5x75 VBA080501

Facility

$24,242.84

Hospital Charge Code	270633717V
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 8x5x75 VBA080501

Facility

$24,242.84

Hospital Charge Code	270633717V
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 8x5x75 VBA080501

Facility

$10,168.00

Hospital Charge Code	270633717
Hospital Revenue Code	278
Min. Negotiated Rate	$245.05
Max. Negotiated Rate	$5,084.00
Rate for Payer: Aetna Commercial	$3,863.84
Rate for Payer: Aetna Medicare Advantage	$3,050.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,592.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,592.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,033.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,592.84
Rate for Payer: Cigna Commercial	$5,084.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,460.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,236.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,525.20
Rate for Payer: UnitedHealthcare Community & State	$245.05
Rate for Payer: Wellpoint Medicaid Managed Care	$269.45

STENT VIABAHN 8x5x75 VBA080501

Facility

$10,168.00

Hospital Charge Code	270633717
Hospital Revenue Code	278
Min. Negotiated Rate	$1,525.20
Max. Negotiated Rate	$2,460.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,033.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,460.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,236.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,525.20

STENT VIABAHN 9FR 9x15 120cm

Facility

$18,975.00

Hospital Charge Code	270669522
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 9FR 9x15 120cm

Facility

$18,975.00

Hospital Charge Code	270669522
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 9x15cm

Facility

$18,975.00

Hospital Charge Code	270671134
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 9x15cm

Facility

$18,975.00

Hospital Charge Code	270671134
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 ENDOPRO 7MMx10CM

Facility

$19,270.00

Service Code	HCPCS C1876
Hospital Charge Code	270676102
Hospital Revenue Code	278
Min. Negotiated Rate	$464.41
Max. Negotiated Rate	$9,635.00
Rate for Payer: Aetna Commercial	$7,322.60
Rate for Payer: Aetna Medicare Advantage	$5,781.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,913.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,913.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,854.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,913.85
Rate for Payer: Cigna Commercial	$9,635.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,663.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,239.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,890.50
Rate for Payer: UnitedHealthcare Community & State	$464.41
Rate for Payer: Wellpoint Medicaid Managed Care	$510.65

STENT VIABAHN ENDOPRO 7MMx10CM

Facility

$19,270.00

Service Code	HCPCS C1876
Hospital Charge Code	270676102
Hospital Revenue Code	278
Min. Negotiated Rate	$2,890.50
Max. Negotiated Rate	$4,663.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,854.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,663.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,239.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,890.50

STENT VIABAHN HEPA 11MMX10CM

Facility

$18,760.00

Service Code	HCPCS C1876
Hospital Charge Code	270687576
Hospital Revenue Code	278
Min. Negotiated Rate	$452.12
Max. Negotiated Rate	$9,380.00
Rate for Payer: Aetna Commercial	$7,128.80
Rate for Payer: Aetna Medicare Advantage	$5,628.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,783.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,783.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,752.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,783.80
Rate for Payer: Cigna Commercial	$9,380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,539.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,127.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,814.00
Rate for Payer: UnitedHealthcare Community & State	$452.12
Rate for Payer: Wellpoint Medicaid Managed Care	$497.14

STENT VIABAHN HEPA 11MMX10CM

Facility

$18,760.00

Service Code	HCPCS C1876
Hospital Charge Code	270687576
Hospital Revenue Code	278
Min. Negotiated Rate	$2,814.00
Max. Negotiated Rate	$4,539.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,752.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,539.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,127.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,814.00

STENT VIABAHN VBX

Facility

$17,850.00

Service Code	HCPCS C1876
Hospital Charge Code	270679851N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,677.50
Max. Negotiated Rate	$4,319.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,319.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,927.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,677.50

STENT VIABAHN VBX

Facility

$18,295.00

Service Code	HCPCS C1876
Hospital Charge Code	270679851
Hospital Revenue Code	278
Min. Negotiated Rate	$2,744.25
Max. Negotiated Rate	$4,427.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,659.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,427.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,024.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,744.25

STENT VIABAHN VBX

Facility

$18,295.00

Service Code	HCPCS C1876
Hospital Charge Code	270679850
Hospital Revenue Code	278
Min. Negotiated Rate	$440.91
Max. Negotiated Rate	$9,147.50
Rate for Payer: Aetna Commercial	$6,952.10
Rate for Payer: Aetna Medicare Advantage	$5,488.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,665.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,665.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,659.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,665.23
Rate for Payer: Cigna Commercial	$9,147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,427.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,024.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,744.25
Rate for Payer: UnitedHealthcare Community & State	$440.91
Rate for Payer: Wellpoint Medicaid Managed Care	$484.82

STENT VIABAHN VBX

Facility

$18,295.00

Service Code	HCPCS C1876
Hospital Charge Code	270679851S
Hospital Revenue Code	278
Min. Negotiated Rate	$440.91
Max. Negotiated Rate	$9,147.50
Rate for Payer: Aetna Commercial	$6,952.10
Rate for Payer: Aetna Medicare Advantage	$5,488.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,665.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,665.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,659.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,665.23
Rate for Payer: Cigna Commercial	$9,147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,427.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,024.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,744.25
Rate for Payer: UnitedHealthcare Community & State	$440.91
Rate for Payer: Wellpoint Medicaid Managed Care	$484.82

STENT VIABAHN VBX

Facility

$18,295.00

Service Code	HCPCS C1876
Hospital Charge Code	270679851S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,744.25
Max. Negotiated Rate	$4,427.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,659.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,427.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,024.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,744.25

Know your out-of-pocket cost for care.

All Charges