Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

VG 360 DST FM AG 62 5X5 LL/RM

Facility

$6,090.00

Service Code	HCPCS C1776
Hospital Charge Code	270687275
Hospital Revenue Code	278
Min. Negotiated Rate	$913.50
Max. Negotiated Rate	$1,473.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,218.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,473.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,339.80
Rate for Payer: Qualcare PPO/HMO/WC	$913.50

VG 360 DST FM AG 62 5X5 RL/LM

Facility

$6,090.00

Service Code	HCPCS C1776
Hospital Charge Code	270687277
Hospital Revenue Code	278
Min. Negotiated Rate	$146.77
Max. Negotiated Rate	$3,045.00
Rate for Payer: Aetna Commercial	$2,314.20
Rate for Payer: Aetna Medicare Advantage	$1,827.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,552.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,552.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,218.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,552.95
Rate for Payer: Cigna Commercial	$3,045.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,473.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,339.80
Rate for Payer: Qualcare PPO/HMO/WC	$913.50
Rate for Payer: UnitedHealthcare Community & State	$146.77
Rate for Payer: Wellpoint Medicaid Managed Care	$161.38

VG 360 DST FM AG 62 5X5 RL/LM

Facility

$6,090.00

Service Code	HCPCS C1776
Hospital Charge Code	270687277
Hospital Revenue Code	278
Min. Negotiated Rate	$913.50
Max. Negotiated Rate	$1,473.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,218.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,473.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,339.80
Rate for Payer: Qualcare PPO/HMO/WC	$913.50

VG 360 UNIV PST FM AUG 62 5X5

Facility

$6,090.00

Service Code	HCPCS C1776
Hospital Charge Code	270687276
Hospital Revenue Code	278
Min. Negotiated Rate	$146.77
Max. Negotiated Rate	$3,045.00
Rate for Payer: Aetna Commercial	$2,314.20
Rate for Payer: Aetna Medicare Advantage	$1,827.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,552.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,552.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,218.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,552.95
Rate for Payer: Cigna Commercial	$3,045.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,473.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,339.80
Rate for Payer: Qualcare PPO/HMO/WC	$913.50
Rate for Payer: UnitedHealthcare Community & State	$146.77
Rate for Payer: Wellpoint Medicaid Managed Care	$161.38

VG 360 UNIV PST FM AUG 62 5X5

Facility

$6,090.00

Service Code	HCPCS C1776
Hospital Charge Code	270687276
Hospital Revenue Code	278
Min. Negotiated Rate	$913.50
Max. Negotiated Rate	$1,473.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,218.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,473.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,339.80
Rate for Payer: Qualcare PPO/HMO/WC	$913.50

VG 5FR SPIROFLEX THROMBECTOMY

Facility

$8,975.00

Service Code	HCPCS C1757
Hospital Charge Code	270645708C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,346.25
Max. Negotiated Rate	$2,171.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,974.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25

VG 5FR SPIROFLEX THROMBECTOMY

Facility

$8,975.00

Service Code	HCPCS C1757
Hospital Charge Code	270645708C
Hospital Revenue Code	278
Min. Negotiated Rate	$216.30
Max. Negotiated Rate	$4,487.50
Rate for Payer: Aetna Commercial	$3,410.50
Rate for Payer: Aetna Medicare Advantage	$2,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,288.62
Rate for Payer: Cigna Commercial	$4,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,974.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25
Rate for Payer: UnitedHealthcare Community & State	$216.30
Rate for Payer: Wellpoint Medicaid Managed Care	$237.84

VG 5FR SPIROFLEX THROMBECTOMY

Facility

$8,975.00

Service Code	HCPCS C1757
Hospital Charge Code	270645708
Hospital Revenue Code	278
Min. Negotiated Rate	$216.30
Max. Negotiated Rate	$4,487.50
Rate for Payer: Aetna Commercial	$3,410.50
Rate for Payer: Aetna Medicare Advantage	$2,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,288.62
Rate for Payer: Cigna Commercial	$4,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,974.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25
Rate for Payer: UnitedHealthcare Community & State	$216.30
Rate for Payer: Wellpoint Medicaid Managed Care	$237.84

VG 5FR SPIROFLEX THROMBECTOMY

Facility

$8,975.00

Service Code	HCPCS C1757
Hospital Charge Code	270645708
Hospital Revenue Code	278
Min. Negotiated Rate	$1,346.25
Max. Negotiated Rate	$2,171.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,974.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25

VG 5FR SPIROFLEX THROMBECTOMY

Facility

$8,975.00

Service Code	HCPCS C1757
Hospital Charge Code	270645708S
Hospital Revenue Code	278
Min. Negotiated Rate	$216.30
Max. Negotiated Rate	$4,487.50
Rate for Payer: Aetna Commercial	$3,410.50
Rate for Payer: Aetna Medicare Advantage	$2,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,288.62
Rate for Payer: Cigna Commercial	$4,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,974.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25
Rate for Payer: UnitedHealthcare Community & State	$216.30
Rate for Payer: Wellpoint Medicaid Managed Care	$237.84

VG 5FR SPIROFLEX THROMBECTOMY

Facility

$10,225.00

Service Code	HCPCS C1757
Hospital Charge Code	270645708O
Hospital Revenue Code	278
Min. Negotiated Rate	$246.42
Max. Negotiated Rate	$5,112.50
Rate for Payer: Aetna Commercial	$3,885.50
Rate for Payer: Aetna Medicare Advantage	$3,067.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,607.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,607.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,045.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,607.38
Rate for Payer: Cigna Commercial	$5,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,474.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,249.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,533.75
Rate for Payer: UnitedHealthcare Community & State	$246.42
Rate for Payer: Wellpoint Medicaid Managed Care	$270.96

VG 5FR SPIROFLEX THROMBECTOMY

Facility

$8,975.00

Service Code	HCPCS C1757
Hospital Charge Code	270645708S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,346.25
Max. Negotiated Rate	$2,171.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,974.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25

VG 5FR SPIROFLEX THROMBECTOMY

Facility

$10,225.00

Service Code	HCPCS C1757
Hospital Charge Code	270645708N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,533.75
Max. Negotiated Rate	$2,474.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,045.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,474.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,249.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,533.75

VG 5FR SPIROFLEX THROMBECTOMY

Facility

$10,225.00

Service Code	HCPCS C1757
Hospital Charge Code	270645708N
Hospital Revenue Code	278
Min. Negotiated Rate	$246.42
Max. Negotiated Rate	$5,112.50
Rate for Payer: Aetna Commercial	$3,885.50
Rate for Payer: Aetna Medicare Advantage	$3,067.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,607.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,607.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,045.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,607.38
Rate for Payer: Cigna Commercial	$5,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,474.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,249.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,533.75
Rate for Payer: UnitedHealthcare Community & State	$246.42
Rate for Payer: Wellpoint Medicaid Managed Care	$270.96

VG 5FR SPIROFLEX THROMBECTOMY

Facility

$10,225.00

Service Code	HCPCS C1757
Hospital Charge Code	270645708O
Hospital Revenue Code	278
Min. Negotiated Rate	$1,533.75
Max. Negotiated Rate	$2,474.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,045.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,474.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,249.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,533.75

VGKC Antibody

Facility

$92.15

Service Code	HCPCS 83519
Hospital Charge Code	39708014
Hospital Revenue Code	301
Min. Negotiated Rate	$13.82
Max. Negotiated Rate	$13.82
Rate for Payer: Qualcare PPO/HMO/WC	$13.82

VGKC Antibody

Facility

$92.15

Service Code	HCPCS 83519
Hospital Charge Code	39708014
Hospital Revenue Code	301
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$50.05
Rate for Payer: Aetna Medicare Advantage	$59.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.42
Rate for Payer: Cigna Commercial	$46.08
Rate for Payer: Cigna Medicare Advantage	$18.40
Rate for Payer: Clover Medicare Advantage	$17.48
Rate for Payer: EmblemHealth Commercial	$55.20
Rate for Payer: Humana Medicare Advantage	$18.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.64
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.82
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.40
Rate for Payer: Wellcare Medicare Advantage	$18.40
Rate for Payer: Wellpoint Medicaid Managed Care	$2.44

VG LAMINOPLASTY

Facility

$4,284.00

Service Code	HCPCS C1713
Hospital Charge Code	270680746
Hospital Revenue Code	278
Min. Negotiated Rate	$642.60
Max. Negotiated Rate	$1,036.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$856.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$942.48
Rate for Payer: Qualcare PPO/HMO/WC	$642.60

VG LAMINOPLASTY

Facility

$4,284.00

Service Code	HCPCS C1713
Hospital Charge Code	270680747
Hospital Revenue Code	278
Min. Negotiated Rate	$642.60
Max. Negotiated Rate	$1,036.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$856.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$942.48
Rate for Payer: Qualcare PPO/HMO/WC	$642.60

VG LAMINOPLASTY

Facility

$4,284.00

Service Code	HCPCS C1713
Hospital Charge Code	270680745
Hospital Revenue Code	278
Min. Negotiated Rate	$103.24
Max. Negotiated Rate	$2,142.00
Rate for Payer: Aetna Commercial	$1,627.92
Rate for Payer: Aetna Medicare Advantage	$1,285.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,092.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,092.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$856.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,092.42
Rate for Payer: Cigna Commercial	$2,142.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$942.48
Rate for Payer: Qualcare PPO/HMO/WC	$642.60
Rate for Payer: UnitedHealthcare Community & State	$103.24
Rate for Payer: Wellpoint Medicaid Managed Care	$113.53

VG LAMINOPLASTY

Facility

$4,284.00

Service Code	HCPCS C1713
Hospital Charge Code	270680743
Hospital Revenue Code	278
Min. Negotiated Rate	$103.24
Max. Negotiated Rate	$2,142.00
Rate for Payer: Aetna Commercial	$1,627.92
Rate for Payer: Aetna Medicare Advantage	$1,285.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,092.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,092.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$856.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,092.42
Rate for Payer: Cigna Commercial	$2,142.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$942.48
Rate for Payer: Qualcare PPO/HMO/WC	$642.60
Rate for Payer: UnitedHealthcare Community & State	$103.24
Rate for Payer: Wellpoint Medicaid Managed Care	$113.53

VG LAMINOPLASTY

Facility

$4,284.00

Service Code	HCPCS C1713
Hospital Charge Code	270680745
Hospital Revenue Code	278
Min. Negotiated Rate	$642.60
Max. Negotiated Rate	$1,036.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$856.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$942.48
Rate for Payer: Qualcare PPO/HMO/WC	$642.60

VG LAMINOPLASTY

Facility

$4,284.00

Service Code	HCPCS C1713
Hospital Charge Code	270680744
Hospital Revenue Code	278
Min. Negotiated Rate	$103.24
Max. Negotiated Rate	$2,142.00
Rate for Payer: Aetna Commercial	$1,627.92
Rate for Payer: Aetna Medicare Advantage	$1,285.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,092.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,092.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$856.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,092.42
Rate for Payer: Cigna Commercial	$2,142.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$942.48
Rate for Payer: Qualcare PPO/HMO/WC	$642.60
Rate for Payer: UnitedHealthcare Community & State	$103.24
Rate for Payer: Wellpoint Medicaid Managed Care	$113.53

VG LAMINOPLASTY

Facility

$4,284.00

Service Code	HCPCS C1713
Hospital Charge Code	270680743
Hospital Revenue Code	278
Min. Negotiated Rate	$642.60
Max. Negotiated Rate	$1,036.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$856.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$942.48
Rate for Payer: Qualcare PPO/HMO/WC	$642.60

VG LAMINOPLASTY

Facility

$4,284.00

Service Code	HCPCS C1713
Hospital Charge Code	270680744
Hospital Revenue Code	278
Min. Negotiated Rate	$642.60
Max. Negotiated Rate	$1,036.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$856.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$942.48
Rate for Payer: Qualcare PPO/HMO/WC	$642.60

Know your out-of-pocket cost for care.

All Charges