Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ILIAC STENT W/PTA ADD-RT

Facility

$15,877.00

Service Code	HCPCS 37223RT
Hospital Charge Code	366837223R
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 STENT W/PTA-BI

Facility

$62,620.72

Service Code	HCPCS 3722150
Hospital Charge Code	321037221B
Hospital Revenue Code	361
Min. Negotiated Rate	$9,393.11
Max. Negotiated Rate	$9,393.11
Rate for Payer: Qualcare PPO/HMO/WC	$9,393.11

ILIAC STENT W/PTA-BI

Facility

$62,620.72

Service Code	HCPCS 3722150
Hospital Charge Code	2690500
Hospital Revenue Code	361
Min. Negotiated Rate	$9,393.11
Max. Negotiated Rate	$9,393.11
Rate for Payer: Qualcare PPO/HMO/WC	$9,393.11

ILIAC STENT W/PTA-BI

Facility

$62,620.72

Service Code	HCPCS 3722150
Hospital Charge Code	3668372215
Hospital Revenue Code	361
Min. Negotiated Rate	$1,509.16
Max. Negotiated Rate	$31,310.36
Rate for Payer: Aetna Commercial	$23,795.87
Rate for Payer: Aetna Medicare Advantage	$18,786.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,968.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,968.28
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	$15,968.28
Rate for Payer: Cigna Commercial	$31,310.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,786.22
Rate for Payer: Qualcare PPO/HMO/WC	$9,393.11
Rate for Payer: UnitedHealthcare Community & State	$1,509.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1,659.45

ILIAC STENT W/PTA-BI

Facility

$62,620.72

Service Code	HCPCS 3722150
Hospital Charge Code	321037221B
Hospital Revenue Code	361
Min. Negotiated Rate	$1,509.16
Max. Negotiated Rate	$31,310.36
Rate for Payer: Aetna Commercial	$23,795.87
Rate for Payer: Aetna Medicare Advantage	$18,786.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,968.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,968.28
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	$15,968.28
Rate for Payer: Cigna Commercial	$31,310.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,786.22
Rate for Payer: Qualcare PPO/HMO/WC	$9,393.11
Rate for Payer: UnitedHealthcare Community & State	$1,509.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1,659.45

ILIAC STENT W/PTA-BI

Facility

$62,620.72

Service Code	HCPCS 3722150
Hospital Charge Code	2690500
Hospital Revenue Code	361
Min. Negotiated Rate	$1,509.16
Max. Negotiated Rate	$31,310.36
Rate for Payer: Aetna Commercial	$23,795.87
Rate for Payer: Aetna Medicare Advantage	$18,786.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,968.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,968.28
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	$15,968.28
Rate for Payer: Cigna Commercial	$31,310.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,786.22
Rate for Payer: Qualcare PPO/HMO/WC	$9,393.11
Rate for Payer: UnitedHealthcare Community & State	$1,509.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1,659.45

ILIAC STENT W/PTA-BI

Facility

$62,620.72

Service Code	HCPCS 3722150
Hospital Charge Code	411037221B
Hospital Revenue Code	361
Min. Negotiated Rate	$9,393.11
Max. Negotiated Rate	$9,393.11
Rate for Payer: Qualcare PPO/HMO/WC	$9,393.11

ILIAC STENT W/PTA-BI

Facility

$62,620.72

Service Code	HCPCS 3722150
Hospital Charge Code	3668372215
Hospital Revenue Code	361
Min. Negotiated Rate	$9,393.11
Max. Negotiated Rate	$9,393.11
Rate for Payer: Qualcare PPO/HMO/WC	$9,393.11

ILIAC STENT W/PTA-BI

Facility

$62,620.72

Service Code	HCPCS 3722150
Hospital Charge Code	411037221B
Hospital Revenue Code	361
Min. Negotiated Rate	$1,509.16
Max. Negotiated Rate	$31,310.36
Rate for Payer: Aetna Commercial	$23,795.87
Rate for Payer: Aetna Medicare Advantage	$18,786.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,968.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,968.28
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	$15,968.28
Rate for Payer: Cigna Commercial	$31,310.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,786.22
Rate for Payer: Qualcare PPO/HMO/WC	$9,393.11
Rate for Payer: UnitedHealthcare Community & State	$1,509.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1,659.45

ILIAC STENT W/PTA-LT

Facility

$61,616.39

Service Code	HCPCS 37221LT
Hospital Charge Code	2691330
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 STENT W/PTA-LT

Facility

$61,616.39

Service Code	HCPCS 37221LT
Hospital Charge Code	321037221L
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 STENT W/PTA-LT

Facility

$61,616.39

Service Code	HCPCS 37221LT
Hospital Charge Code	321037221L
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 STENT W/PTA-LT

Facility

$61,616.39

Service Code	HCPCS 37221LT
Hospital Charge Code	2691330
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 STENT W/PTA-RT

Facility

$61,616.39

Service Code	HCPCS 37221RT
Hospital Charge Code	2691335
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 STENT W/PTA-RT

Facility

$61,616.39

Service Code	HCPCS 37221RT
Hospital Charge Code	2691335
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 STENT W/PTA-RT

Facility

$61,616.39

Service Code	HCPCS 37221RT
Hospital Charge Code	321037221R
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 STENT W/PTA-RT

Facility

$61,616.39

Service Code	HCPCS 37221RT
Hospital Charge Code	321037221R
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 STENT W/PTA UNI

Facility

$15,877.00

Service Code	HCPCS 37258
Hospital Charge Code	411037221
Hospital Revenue Code	361
Min. Negotiated Rate	$382.64
Max. Negotiated Rate	$49,506.31
Rate for Payer: Aetna Commercial	$37,304.26
Rate for Payer: Aetna Medicare Advantage	$44,435.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,506.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,506.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,714.80
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	$49,506.31
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: Cigna Medicare Advantage	$13,714.80
Rate for Payer: Clover Medicare Advantage	$13,029.06
Rate for Payer: EmblemHealth Commercial	$41,144.40
Rate for Payer: Humana Medicare Advantage	$14,126.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,714.80
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: UnitedHealthcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare Medicare Advantage	$13,714.80
Rate for Payer: Wellpoint Medicaid Managed Care	$420.74

ILIAC STENT W/PTA UNI

Facility

$15,877.00

Service Code	HCPCS 37258
Hospital Charge Code	411037221
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

ILLIAC ASPIR NEEDLE

Facility

$60.00

Hospital Charge Code	93500170
Hospital Revenue Code	272
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

ILLIAC ASPIR NEEDLE

Facility

$60.00

Hospital Charge Code	93500107
Hospital Revenue Code	272
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Commercial	$22.80
Rate for Payer: Aetna Medicare Advantage	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.30
Rate for Payer: Cigna Commercial	$30.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.00
Rate for Payer: Oxford Commercial	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
Rate for Payer: UnitedHealthcare Commercial	$12.00
Rate for Payer: UnitedHealthcare Community & State	$1.45
Rate for Payer: Wellpoint Medicaid Managed Care	$1.59

ILLIAC ASPIR NEEDLE

Facility

$60.00

Hospital Charge Code	93500170
Hospital Revenue Code	272
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Commercial	$22.80
Rate for Payer: Aetna Medicare Advantage	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.30
Rate for Payer: Cigna Commercial	$30.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.00
Rate for Payer: Oxford Commercial	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
Rate for Payer: UnitedHealthcare Commercial	$12.00
Rate for Payer: UnitedHealthcare Community & State	$1.45
Rate for Payer: Wellpoint Medicaid Managed Care	$1.59

ILLIAC ASPIR NEEDLE

Facility

$60.00

Hospital Charge Code	93500107
Hospital Revenue Code	272
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

ILLIAC LEG CONLTL 16x54 258364

Facility

$13,392.00

Hospital Charge Code	270632726
Hospital Revenue Code	272
Min. Negotiated Rate	$322.75
Max. Negotiated Rate	$6,696.00
Rate for Payer: Aetna Commercial	$5,088.96
Rate for Payer: Aetna Medicare Advantage	$4,017.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,414.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,414.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,414.96
Rate for Payer: Cigna Commercial	$6,696.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,017.60
Rate for Payer: Oxford Commercial	$2,678.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,008.80
Rate for Payer: UnitedHealthcare Commercial	$2,678.40
Rate for Payer: UnitedHealthcare Community & State	$322.75
Rate for Payer: Wellpoint Medicaid Managed Care	$354.89

ILLIAC LEG CONLTL 16x54 258364

Facility

$13,392.00

Hospital Charge Code	270632726
Hospital Revenue Code	272
Min. Negotiated Rate	$2,008.80
Max. Negotiated Rate	$2,008.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,008.80

Know your out-of-pocket cost for care.

All Charges