Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT VISI-PRO 6X57X80

Facility

$5,198.90

Service Code	HCPCS C1876
Hospital Charge Code	270683563N
Hospital Revenue Code	278
Min. Negotiated Rate	$779.84
Max. Negotiated Rate	$1,258.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,039.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,258.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,143.76
Rate for Payer: Qualcare PPO/HMO/WC	$779.84

STENT VISI-PRO 6X57X80

Facility

$5,198.90

Service Code	HCPCS C1876
Hospital Charge Code	270683563
Hospital Revenue Code	278
Min. Negotiated Rate	$779.84
Max. Negotiated Rate	$1,258.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,039.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,258.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,143.76
Rate for Payer: Qualcare PPO/HMO/WC	$779.84

STENT VISI PRO 7x27x135CM

Facility

$4,500.00

Hospital Charge Code	270644829
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 VISI PRO 7x27x135CM

Facility

$4,500.00

Hospital Charge Code	270644829
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 VISI-PRO 7X27X135CM

Facility

$4,500.00

Hospital Charge Code	270644829C
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 VISI-PRO 7X27X135CM

Facility

$4,500.00

Hospital Charge Code	270644829C
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 VISI PRO 7x57x135CM

Facility

$4,500.00

Hospital Charge Code	270644832
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 VISI PRO 7x57x135CM

Facility

$4,500.00

Hospital Charge Code	270644832
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 VISI-PRO 7X57X135CM

Facility

$4,500.00

Hospital Charge Code	270644832C
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 VISI-PRO 7X57X135CM

Facility

$4,500.00

Hospital Charge Code	270644832C
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 VISIPRO 7X57X80

Facility

$6,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270661818
Hospital Revenue Code	278
Min. Negotiated Rate	$971.25
Max. Negotiated Rate	$1,566.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,566.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,424.50
Rate for Payer: Qualcare PPO/HMO/WC	$971.25

STENT VISIPRO 7X57X80

Facility

$6,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270661818
Hospital Revenue Code	278
Min. Negotiated Rate	$156.05
Max. Negotiated Rate	$3,237.50
Rate for Payer: Aetna Commercial	$2,460.50
Rate for Payer: Aetna Medicare Advantage	$1,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,651.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,651.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,651.12
Rate for Payer: Cigna Commercial	$3,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,566.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,424.50
Rate for Payer: Qualcare PPO/HMO/WC	$971.25
Rate for Payer: UnitedHealthcare Community & State	$156.05
Rate for Payer: Wellpoint Medicaid Managed Care	$171.59

STENT VISIPRO 7X57X80

Facility

$6,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270661818N
Hospital Revenue Code	278
Min. Negotiated Rate	$971.25
Max. Negotiated Rate	$1,566.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,566.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,424.50
Rate for Payer: Qualcare PPO/HMO/WC	$971.25

STENT VISIPRO 7X57X80

Facility

$6,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270661818N
Hospital Revenue Code	278
Min. Negotiated Rate	$156.05
Max. Negotiated Rate	$3,237.50
Rate for Payer: Aetna Commercial	$2,460.50
Rate for Payer: Aetna Medicare Advantage	$1,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,651.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,651.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,651.12
Rate for Payer: Cigna Commercial	$3,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,566.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,424.50
Rate for Payer: Qualcare PPO/HMO/WC	$971.25
Rate for Payer: UnitedHealthcare Community & State	$156.05
Rate for Payer: Wellpoint Medicaid Managed Care	$171.59

STENT VISI PRO 8x27x135CM

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270643692
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 VISI PRO 8x27x135CM

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270643692
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 VISI-PRO 8x37x135cm

Facility

$5,198.90

Service Code	HCPCS C1876
Hospital Charge Code	270644834
Hospital Revenue Code	278
Min. Negotiated Rate	$779.84
Max. Negotiated Rate	$1,258.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,039.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,258.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,143.76
Rate for Payer: Qualcare PPO/HMO/WC	$779.84

STENT VISI-PRO 8x37x135cm

Facility

$5,198.90

Service Code	HCPCS C1876
Hospital Charge Code	270644834
Hospital Revenue Code	278
Min. Negotiated Rate	$125.29
Max. Negotiated Rate	$2,599.45
Rate for Payer: Aetna Commercial	$1,975.58
Rate for Payer: Aetna Medicare Advantage	$1,559.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,325.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,325.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,039.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,325.72
Rate for Payer: Cigna Commercial	$2,599.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,258.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,143.76
Rate for Payer: Qualcare PPO/HMO/WC	$779.84
Rate for Payer: UnitedHealthcare Community & State	$125.29
Rate for Payer: Wellpoint Medicaid Managed Care	$137.77

STENT VISI-PRO 8x37x135cm

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270644834O
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 VISI-PRO 8x37x135cm

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270644834O
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 VISI PRO 8x57x135CM

Facility

$4,500.00

Hospital Charge Code	270644836
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 VISI PRO 8x57x135CM

Facility

$4,500.00

Hospital Charge Code	270644836
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 VISIPRO 9X17X80

Facility

$5,198.90

Service Code	HCPCS C1876
Hospital Charge Code	270683537
Hospital Revenue Code	278
Min. Negotiated Rate	$779.84
Max. Negotiated Rate	$1,258.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,039.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,258.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,143.76
Rate for Payer: Qualcare PPO/HMO/WC	$779.84

STENT VISIPRO 9X17X80

Facility

$5,198.90

Service Code	HCPCS C1876
Hospital Charge Code	270683537
Hospital Revenue Code	278
Min. Negotiated Rate	$125.29
Max. Negotiated Rate	$2,599.45
Rate for Payer: Aetna Commercial	$1,975.58
Rate for Payer: Aetna Medicare Advantage	$1,559.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,325.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,325.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,039.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,325.72
Rate for Payer: Cigna Commercial	$2,599.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,258.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,143.76
Rate for Payer: Qualcare PPO/HMO/WC	$779.84
Rate for Payer: UnitedHealthcare Community & State	$125.29
Rate for Payer: Wellpoint Medicaid Managed Care	$137.77

STENT VISIPRO 9X17X80

Facility

$5,198.90

Service Code	HCPCS C1876
Hospital Charge Code	270683537N
Hospital Revenue Code	278
Min. Negotiated Rate	$125.29
Max. Negotiated Rate	$2,599.45
Rate for Payer: Aetna Commercial	$1,975.58
Rate for Payer: Aetna Medicare Advantage	$1,559.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,325.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,325.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,039.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,325.72
Rate for Payer: Cigna Commercial	$2,599.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,258.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,143.76
Rate for Payer: Qualcare PPO/HMO/WC	$779.84
Rate for Payer: UnitedHealthcare Community & State	$125.29
Rate for Payer: Wellpoint Medicaid Managed Care	$137.77

Know your out-of-pocket cost for care.

All Charges