Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ILIAC PTA ADD EA-LT

Facility

$15,877.00

Service Code	HCPCS 37222LT
Hospital Charge Code	7411920
Hospital Revenue Code	361
Min. Negotiated Rate	$2,381.55
Max. Negotiated Rate	$2,381.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

ILIAC PTA ADD EA-LT

Facility

$22,441.40

Service Code	HCPCS 37222LT
Hospital Charge Code	321037222L
Hospital Revenue Code	361
Min. Negotiated Rate	$540.84
Max. Negotiated Rate	$11,220.70
Rate for Payer: Aetna Commercial	$8,527.73
Rate for Payer: Aetna Medicare Advantage	$6,732.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,722.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,722.56
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	$5,722.56
Rate for Payer: Cigna Commercial	$11,220.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,732.42
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21
Rate for Payer: UnitedHealthcare Community & State	$540.84
Rate for Payer: Wellpoint Medicaid Managed Care	$594.70

ILIAC PTA ADD EA-LT

Facility

$22,441.40

Service Code	HCPCS 37222LT
Hospital Charge Code	321037222L
Hospital Revenue Code	361
Min. Negotiated Rate	$3,366.21
Max. Negotiated Rate	$3,366.21
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21

ILIAC PTA ADD EA-LT

Facility

$22,441.40

Service Code	HCPCS 37222LT
Hospital Charge Code	41037222L
Hospital Revenue Code	361
Min. Negotiated Rate	$3,366.21
Max. Negotiated Rate	$3,366.21
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21

ILIAC PTA ADD EA-LT

Facility

$22,441.40

Service Code	HCPCS 37222LT
Hospital Charge Code	2691340
Hospital Revenue Code	361
Min. Negotiated Rate	$540.84
Max. Negotiated Rate	$11,220.70
Rate for Payer: Aetna Commercial	$8,527.73
Rate for Payer: Aetna Medicare Advantage	$6,732.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,722.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,722.56
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	$5,722.56
Rate for Payer: Cigna Commercial	$11,220.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,732.42
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21
Rate for Payer: UnitedHealthcare Community & State	$540.84
Rate for Payer: Wellpoint Medicaid Managed Care	$594.70

ILIAC PTA ADD EA-LT

Facility

$22,441.40

Service Code	HCPCS 37222LT
Hospital Charge Code	2691340
Hospital Revenue Code	361
Min. Negotiated Rate	$3,366.21
Max. Negotiated Rate	$3,366.21
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21

ILIAC PTA ADD EA-LT

Facility

$22,441.40

Service Code	HCPCS 37222LT
Hospital Charge Code	366837222
Hospital Revenue Code	361
Min. Negotiated Rate	$540.84
Max. Negotiated Rate	$11,220.70
Rate for Payer: Aetna Commercial	$8,527.73
Rate for Payer: Aetna Medicare Advantage	$6,732.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,722.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,722.56
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	$5,722.56
Rate for Payer: Cigna Commercial	$11,220.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,732.42
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21
Rate for Payer: UnitedHealthcare Community & State	$540.84
Rate for Payer: Wellpoint Medicaid Managed Care	$594.70

ILIAC PTA ADD EA-RT

Facility

$15,877.00

Service Code	HCPCS 37222RT
Hospital Charge Code	2691345
Hospital Revenue Code	361
Min. Negotiated Rate	$2,381.55
Max. Negotiated Rate	$2,381.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

ILIAC PTA ADD EA-RT

Facility

$15,877.00

Service Code	HCPCS 37222RT
Hospital Charge Code	7411921
Hospital Revenue Code	361
Min. Negotiated Rate	$2,381.55
Max. Negotiated Rate	$2,381.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

ILIAC PTA ADD EA-RT

Facility

$15,877.00

Service Code	HCPCS 37222RT
Hospital Charge Code	7411921
Hospital Revenue Code	361
Min. Negotiated Rate	$382.64
Max. Negotiated Rate	$7,938.50
Rate for Payer: Aetna Commercial	$6,033.26
Rate for Payer: Aetna Medicare Advantage	$4,763.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,048.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,048.64
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	$4,048.64
Rate for Payer: Cigna Commercial	$7,938.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,763.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55
Rate for Payer: UnitedHealthcare Community & State	$382.64
Rate for Payer: Wellpoint Medicaid Managed Care	$420.74

ILIAC PTA ADD EA-RT

Facility

$15,877.00

Service Code	HCPCS 37222RT
Hospital Charge Code	2691345
Hospital Revenue Code	361
Min. Negotiated Rate	$382.64
Max. Negotiated Rate	$7,938.50
Rate for Payer: Aetna Commercial	$6,033.26
Rate for Payer: Aetna Medicare Advantage	$4,763.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,048.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,048.64
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	$4,048.64
Rate for Payer: Cigna Commercial	$7,938.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,763.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55
Rate for Payer: UnitedHealthcare Community & State	$382.64
Rate for Payer: Wellpoint Medicaid Managed Care	$420.74

ILIAC,PTA,ADDITIONAL

Facility

$24,441.40

Service Code	HCPCS 37255
Hospital Charge Code	404637255
Hospital Revenue Code	481
Min. Negotiated Rate	$3,666.21
Max. Negotiated Rate	$3,666.21
Rate for Payer: Qualcare PPO/HMO/WC	$3,666.21

ILIAC,PTA,ADDITIONAL

Facility

$24,441.40

Service Code	HCPCS 37255
Hospital Charge Code	404637255
Hospital Revenue Code	481
Min. Negotiated Rate	$589.04
Max. Negotiated Rate	$12,220.70
Rate for Payer: Aetna Commercial	$9,287.73
Rate for Payer: Aetna Medicare Advantage	$7,332.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,232.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,232.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,232.56
Rate for Payer: Cigna Commercial	$12,220.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,332.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,666.21
Rate for Payer: UnitedHealthcare Community & State	$589.04
Rate for Payer: Wellpoint Medicaid Managed Care	$647.70

ILIAC,PTA,ADDITIONAL

Facility

$24,441.40

Service Code	HCPCS 37255
Hospital Charge Code	403437255
Hospital Revenue Code	481
Min. Negotiated Rate	$3,666.21
Max. Negotiated Rate	$3,666.21
Rate for Payer: Qualcare PPO/HMO/WC	$3,666.21

ILIAC,PTA,ADDITIONAL

Facility

$24,441.40

Service Code	HCPCS 37255
Hospital Charge Code	403437255
Hospital Revenue Code	481
Min. Negotiated Rate	$589.04
Max. Negotiated Rate	$12,220.70
Rate for Payer: Aetna Commercial	$9,287.73
Rate for Payer: Aetna Medicare Advantage	$7,332.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,232.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,232.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,232.56
Rate for Payer: Cigna Commercial	$12,220.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,332.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,666.21
Rate for Payer: UnitedHealthcare Community & State	$589.04
Rate for Payer: Wellpoint Medicaid Managed Care	$647.70

ILIAC REVASC

Facility

$20,340.00

Service Code	HCPCS 37254
Hospital Charge Code	1600000629
Hospital Revenue Code	360
Min. Negotiated Rate	$490.19
Max. Negotiated Rate	$24,407.82
Rate for Payer: Aetna Commercial	$18,391.91
Rate for Payer: Aetna Medicare Advantage	$21,908.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,407.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,407.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,761.73
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	$24,407.82
Rate for Payer: Cigna Commercial	$13,553.85
Rate for Payer: Cigna Medicare Advantage	$6,761.73
Rate for Payer: Clover Medicare Advantage	$6,423.64
Rate for Payer: EmblemHealth Commercial	$20,285.19
Rate for Payer: Humana Medicare Advantage	$6,964.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,761.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,102.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,051.00
Rate for Payer: UnitedHealthcare Community & State	$490.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,761.73
Rate for Payer: Wellcare Medicare Advantage	$6,761.73
Rate for Payer: Wellpoint Medicaid Managed Care	$539.01

ILIAC REVASC

Facility

$20,340.00

Service Code	HCPCS 37254
Hospital Charge Code	1600000629
Hospital Revenue Code	360
Min. Negotiated Rate	$3,051.00
Max. Negotiated Rate	$3,051.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,051.00

ILIAC REVASC W/STENT-BI

Facility

$61,616.39

Service Code	HCPCS 3722150
Hospital Charge Code	7411139
Hospital Revenue Code	361
Min. Negotiated Rate	$1,484.95
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,484.92
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,484.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1,632.83

ILIAC REVASC W/STENT-BI

Facility

$61,616.39

Service Code	HCPCS 3722150
Hospital Charge Code	7411139
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

ILIAC REVASC W/STENT-LT

Facility

$61,616.39

Service Code	HCPCS 37221LT
Hospital Charge Code	366837221L
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

ILIAC REVASC W/STENT-LT

Facility

$61,616.39

Service Code	HCPCS 37221LT
Hospital Charge Code	366837221L
Hospital Revenue Code	361
Min. Negotiated Rate	$1,484.95
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,484.92
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,484.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1,632.83

ILIAC REVASC W/STENT-LT

Facility

$61,616.39

Service Code	HCPCS 37221LT
Hospital Charge Code	7411141
Hospital Revenue Code	361
Min. Negotiated Rate	$1,484.95
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,484.92
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,484.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1,632.83

ILIAC REVASC W/STENT-LT

Facility

$61,616.39

Service Code	HCPCS 37221LT
Hospital Charge Code	7411141
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

ILIAC REVASC W/STENT-RT

Facility

$61,616.39

Service Code	HCPCS 37221RT
Hospital Charge Code	366837221R
Hospital Revenue Code	361
Min. Negotiated Rate	$1,484.95
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,484.92
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,484.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1,632.83

ILIAC REVASC W/STENT-RT

Facility

$61,616.39

Service Code	HCPCS 37221RT
Hospital Charge Code	7411143
Hospital Revenue Code	361
Min. Negotiated Rate	$1,484.95
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,484.92
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,484.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1,632.83

Know your out-of-pocket cost for care.

All Charges