Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FEM-POP STENT W/PTA-BI

Facility

$75,737.34

Service Code	HCPCS 3722650
Hospital Charge Code	7411805
Hospital Revenue Code	361
Min. Negotiated Rate	$11,360.60
Max. Negotiated Rate	$11,360.60
Rate for Payer: Qualcare PPO/HMO/WC	$11,360.60

FEM-POP STENT W/PTA-BI

Facility

$75,737.34

Service Code	HCPCS 3722650
Hospital Charge Code	2690530
Hospital Revenue Code	361
Min. Negotiated Rate	$11,360.60
Max. Negotiated Rate	$11,360.60
Rate for Payer: Qualcare PPO/HMO/WC	$11,360.60

FEM-POP STENT W/PTA-BI

Facility

$75,737.34

Service Code	HCPCS 3722650
Hospital Charge Code	2690530
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$37,868.67
Rate for Payer: Aetna Commercial	$28,780.19
Rate for Payer: Aetna Medicare Advantage	$22,721.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19,313.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19,313.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19,313.02
Rate for Payer: Cigna Commercial	$37,868.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22,721.20
Rate for Payer: Qualcare PPO/HMO/WC	$11,360.60
Rate for Payer: UnitedHealthcare Community & State	$1,825.27
Rate for Payer: Wellpoint Medicaid Managed Care	$2,007.04

FEM-POP STENT W/PTA-LT

Facility

$75,737.34

Service Code	HCPCS 37226LT
Hospital Charge Code	2691390
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$37,868.67
Rate for Payer: Aetna Commercial	$28,780.19
Rate for Payer: Aetna Medicare Advantage	$22,721.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19,313.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19,313.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19,313.02
Rate for Payer: Cigna Commercial	$37,868.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22,721.20
Rate for Payer: Qualcare PPO/HMO/WC	$11,360.60
Rate for Payer: UnitedHealthcare Community & State	$1,825.27
Rate for Payer: Wellpoint Medicaid Managed Care	$2,007.04

FEM-POP STENT W/PTA-LT

Facility

$75,737.34

Service Code	HCPCS 37226LT
Hospital Charge Code	7411930
Hospital Revenue Code	361
Min. Negotiated Rate	$11,360.60
Max. Negotiated Rate	$11,360.60
Rate for Payer: Qualcare PPO/HMO/WC	$11,360.60

FEM-POP STENT W/PTA-LT

Facility

$75,737.34

Service Code	HCPCS 37226LT
Hospital Charge Code	321037226L
Hospital Revenue Code	361
Min. Negotiated Rate	$11,360.60
Max. Negotiated Rate	$11,360.60
Rate for Payer: Qualcare PPO/HMO/WC	$11,360.60

FEM-POP STENT W/PTA-LT

Facility

$75,737.34

Service Code	HCPCS 37226LT
Hospital Charge Code	321037226L
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$37,868.67
Rate for Payer: Aetna Commercial	$28,780.19
Rate for Payer: Aetna Medicare Advantage	$22,721.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19,313.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19,313.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19,313.02
Rate for Payer: Cigna Commercial	$37,868.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22,721.20
Rate for Payer: Qualcare PPO/HMO/WC	$11,360.60
Rate for Payer: UnitedHealthcare Community & State	$1,825.27
Rate for Payer: Wellpoint Medicaid Managed Care	$2,007.04

FEM-POP STENT W/PTA-LT

Facility

$75,737.34

Service Code	HCPCS 37226LT
Hospital Charge Code	366837226L
Hospital Revenue Code	361
Min. Negotiated Rate	$11,360.60
Max. Negotiated Rate	$11,360.60
Rate for Payer: Qualcare PPO/HMO/WC	$11,360.60

FEM-POP STENT W/PTA-LT

Facility

$75,737.34

Service Code	HCPCS 37226LT
Hospital Charge Code	366837226L
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$37,868.67
Rate for Payer: Aetna Commercial	$28,780.19
Rate for Payer: Aetna Medicare Advantage	$22,721.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19,313.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19,313.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19,313.02
Rate for Payer: Cigna Commercial	$37,868.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22,721.20
Rate for Payer: Qualcare PPO/HMO/WC	$11,360.60
Rate for Payer: UnitedHealthcare Community & State	$1,825.27
Rate for Payer: Wellpoint Medicaid Managed Care	$2,007.04

FEM-POP STENT W/PTA-LT

Facility

$75,737.34

Service Code	HCPCS 37226LT
Hospital Charge Code	7411930
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$37,868.67
Rate for Payer: Aetna Commercial	$28,780.19
Rate for Payer: Aetna Medicare Advantage	$22,721.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19,313.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19,313.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19,313.02
Rate for Payer: Cigna Commercial	$37,868.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22,721.20
Rate for Payer: Qualcare PPO/HMO/WC	$11,360.60
Rate for Payer: UnitedHealthcare Community & State	$1,825.27
Rate for Payer: Wellpoint Medicaid Managed Care	$2,007.04

FEM-POP STENT W/PTA-LT

Facility

$75,737.34

Service Code	HCPCS 37226LT
Hospital Charge Code	2691390
Hospital Revenue Code	361
Min. Negotiated Rate	$11,360.60
Max. Negotiated Rate	$11,360.60
Rate for Payer: Qualcare PPO/HMO/WC	$11,360.60

FEM-POP STENT W/PTA-RT

Facility

$75,737.34

Service Code	HCPCS 37226RT
Hospital Charge Code	321037226R
Hospital Revenue Code	361
Min. Negotiated Rate	$11,360.60
Max. Negotiated Rate	$11,360.60
Rate for Payer: Qualcare PPO/HMO/WC	$11,360.60

FEM-POP STENT W/PTA-RT

Facility

$75,737.34

Service Code	HCPCS 37226RT
Hospital Charge Code	321037226R
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$37,868.67
Rate for Payer: Aetna Commercial	$28,780.19
Rate for Payer: Aetna Medicare Advantage	$22,721.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19,313.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19,313.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19,313.02
Rate for Payer: Cigna Commercial	$37,868.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22,721.20
Rate for Payer: Qualcare PPO/HMO/WC	$11,360.60
Rate for Payer: UnitedHealthcare Community & State	$1,825.27
Rate for Payer: Wellpoint Medicaid Managed Care	$2,007.04

FEM-POP STENT W/PTA-RT

Facility

$75,737.34

Service Code	HCPCS 37226RT
Hospital Charge Code	366837226R
Hospital Revenue Code	361
Min. Negotiated Rate	$11,360.60
Max. Negotiated Rate	$11,360.60
Rate for Payer: Qualcare PPO/HMO/WC	$11,360.60

FEM-POP STENT W/PTA-RT

Facility

$75,737.34

Service Code	HCPCS 37226RT
Hospital Charge Code	2691395
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$37,868.67
Rate for Payer: Aetna Commercial	$28,780.19
Rate for Payer: Aetna Medicare Advantage	$22,721.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19,313.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19,313.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19,313.02
Rate for Payer: Cigna Commercial	$37,868.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22,721.20
Rate for Payer: Qualcare PPO/HMO/WC	$11,360.60
Rate for Payer: UnitedHealthcare Community & State	$1,825.27
Rate for Payer: Wellpoint Medicaid Managed Care	$2,007.04

FEM-POP STENT W/PTA-RT

Facility

$75,737.34

Service Code	HCPCS 37226RT
Hospital Charge Code	7411931
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$37,868.67
Rate for Payer: Aetna Commercial	$28,780.19
Rate for Payer: Aetna Medicare Advantage	$22,721.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19,313.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19,313.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19,313.02
Rate for Payer: Cigna Commercial	$37,868.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22,721.20
Rate for Payer: Qualcare PPO/HMO/WC	$11,360.60
Rate for Payer: UnitedHealthcare Community & State	$1,825.27
Rate for Payer: Wellpoint Medicaid Managed Care	$2,007.04

FEM-POP STENT W/PTA-RT

Facility

$75,737.34

Service Code	HCPCS 37226RT
Hospital Charge Code	7411931
Hospital Revenue Code	361
Min. Negotiated Rate	$11,360.60
Max. Negotiated Rate	$11,360.60
Rate for Payer: Qualcare PPO/HMO/WC	$11,360.60

FEM-POP STENT W/PTA-RT

Facility

$75,737.34

Service Code	HCPCS 37226RT
Hospital Charge Code	366837226R
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$37,868.67
Rate for Payer: Aetna Commercial	$28,780.19
Rate for Payer: Aetna Medicare Advantage	$22,721.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19,313.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19,313.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19,313.02
Rate for Payer: Cigna Commercial	$37,868.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22,721.20
Rate for Payer: Qualcare PPO/HMO/WC	$11,360.60
Rate for Payer: UnitedHealthcare Community & State	$1,825.27
Rate for Payer: Wellpoint Medicaid Managed Care	$2,007.04

FEM-POP STENT W/PTA-RT

Facility

$75,737.34

Service Code	HCPCS 37226RT
Hospital Charge Code	2691395
Hospital Revenue Code	361
Min. Negotiated Rate	$11,360.60
Max. Negotiated Rate	$11,360.60
Rate for Payer: Qualcare PPO/HMO/WC	$11,360.60

FEM POR CR 72.5M LT 183073

Facility

$17,420.00

Hospital Charge Code	270640763
Hospital Revenue Code	278
Min. Negotiated Rate	$419.82
Max. Negotiated Rate	$8,710.00
Rate for Payer: Aetna Commercial	$6,619.60
Rate for Payer: Aetna Medicare Advantage	$5,226.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,442.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,442.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,442.10
Rate for Payer: Cigna Commercial	$8,710.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,215.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,832.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,613.00
Rate for Payer: UnitedHealthcare Community & State	$419.82
Rate for Payer: Wellpoint Medicaid Managed Care	$461.63

FEM POR CR 72.5M LT 183073

Facility

$17,420.00

Hospital Charge Code	270640763
Hospital Revenue Code	278
Min. Negotiated Rate	$2,613.00
Max. Negotiated Rate	$4,215.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,484.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,215.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,832.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,613.00

FEM POROUS CR 75MM RT 183054

Facility

$17,420.00

Hospital Charge Code	270640761
Hospital Revenue Code	278
Min. Negotiated Rate	$2,613.00
Max. Negotiated Rate	$4,215.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,484.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,215.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,832.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,613.00

FEM POROUS CR 75MM RT 183054

Facility

$17,420.00

Hospital Charge Code	270640761
Hospital Revenue Code	278
Min. Negotiated Rate	$419.82
Max. Negotiated Rate	$8,710.00
Rate for Payer: Aetna Commercial	$6,619.60
Rate for Payer: Aetna Medicare Advantage	$5,226.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,442.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,442.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,442.10
Rate for Payer: Cigna Commercial	$8,710.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,215.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,832.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,613.00
Rate for Payer: UnitedHealthcare Community & State	$419.82
Rate for Payer: Wellpoint Medicaid Managed Care	$461.63

FEM PS INTERLOK 75MM LT 183134

Facility

$15,770.00

Hospital Charge Code	270640577
Hospital Revenue Code	278
Min. Negotiated Rate	$380.06
Max. Negotiated Rate	$7,885.00
Rate for Payer: Aetna Commercial	$5,992.60
Rate for Payer: Aetna Medicare Advantage	$4,731.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,021.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,021.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,154.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,021.35
Rate for Payer: Cigna Commercial	$7,885.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,816.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,469.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,365.50
Rate for Payer: UnitedHealthcare Community & State	$380.06
Rate for Payer: Wellpoint Medicaid Managed Care	$417.90

FEM PS INTERLOK 75MM LT 183134

Facility

$15,770.00

Hospital Charge Code	270640577
Hospital Revenue Code	278
Min. Negotiated Rate	$2,365.50
Max. Negotiated Rate	$3,816.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,154.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,816.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,469.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,365.50

Know your out-of-pocket cost for care.

All Charges