Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR PTA BALLOON ILIAC UNILAT

Facility

$21,962.30

Hospital Charge Code	2011170
Hospital Revenue Code	480
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

IR PTA BALLOON RENAL OR VIS EA

Facility

$21,962.30

Service Code	HCPCS 35471
Hospital Charge Code	2000845
Hospital Revenue Code	361
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

IR PTA BALLOON RENAL OR VIS EA

Facility

$21,962.30

Service Code	HCPCS 35471
Hospital Charge Code	2000845
Hospital Revenue Code	361
Min. Negotiated Rate	$529.29
Max. Negotiated Rate	$10,981.15
Rate for Payer: Aetna Commercial	$8,345.67
Rate for Payer: Aetna Medicare Advantage	$6,588.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.39
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	$5,600.39
Rate for Payer: Cigna Commercial	$10,981.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,588.69
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34
Rate for Payer: UnitedHealthcare Community & State	$529.29
Rate for Payer: Wellpoint Medicaid Managed Care	$582.00

IR PTA BALLOON RENAL OR VIS EA

Facility

$21,962.30

Service Code	HCPCS 35471
Hospital Charge Code	7411406
Hospital Revenue Code	361
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

IR PTA BALLOON RENAL OR VIS EA

Facility

$21,962.30

Service Code	HCPCS 35471
Hospital Charge Code	7411406
Hospital Revenue Code	361
Min. Negotiated Rate	$529.29
Max. Negotiated Rate	$10,981.15
Rate for Payer: Aetna Commercial	$8,345.67
Rate for Payer: Aetna Medicare Advantage	$6,588.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.39
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	$5,600.39
Rate for Payer: Cigna Commercial	$10,981.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,588.69
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34
Rate for Payer: UnitedHealthcare Community & State	$529.29
Rate for Payer: Wellpoint Medicaid Managed Care	$582.00

IR PTA ILIAC ART BILAT

Facility

$21,962.30

Service Code	HCPCS 75962
Hospital Charge Code	2011185
Hospital Revenue Code	320
Min. Negotiated Rate	$529.29
Max. Negotiated Rate	$10,981.15
Rate for Payer: Aetna Commercial	$8,345.67
Rate for Payer: Aetna Medicare Advantage	$6,588.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,600.39
Rate for Payer: Cigna Commercial	$10,981.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,588.69
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$529.29
Rate for Payer: Wellpoint Medicaid Managed Care	$582.00

IR PTA ILIAC ART BILAT

Facility

$21,962.30

Service Code	HCPCS 75962
Hospital Charge Code	2011185
Hospital Revenue Code	320
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

IR-PTA ILIAC ARTERY

Facility

$21,962.00

Service Code	HCPCS 35473
Hospital Charge Code	2680155
Hospital Revenue Code	361
Min. Negotiated Rate	$3,294.30
Max. Negotiated Rate	$3,294.30
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.30

IR-PTA ILIAC ARTERY

Facility

$21,962.00

Service Code	HCPCS 35473
Hospital Charge Code	2680155
Hospital Revenue Code	361
Min. Negotiated Rate	$529.28
Max. Negotiated Rate	$10,981.00
Rate for Payer: Aetna Commercial	$8,345.56
Rate for Payer: Aetna Medicare Advantage	$6,588.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.31
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	$5,600.31
Rate for Payer: Cigna Commercial	$10,981.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,588.60
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.30
Rate for Payer: UnitedHealthcare Community & State	$529.28
Rate for Payer: Wellpoint Medicaid Managed Care	$581.99

IR PTA PERPHRAL ARTRY OTHER S&

Facility

$21,962.30

Service Code	HCPCS 75962
Hospital Charge Code	7411736
Hospital Revenue Code	320
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

IR PTA PERPHRAL ARTRY OTHER S&

Facility

$21,962.30

Service Code	HCPCS 75962
Hospital Charge Code	2011180
Hospital Revenue Code	320
Min. Negotiated Rate	$529.29
Max. Negotiated Rate	$10,981.15
Rate for Payer: Aetna Commercial	$8,345.67
Rate for Payer: Aetna Medicare Advantage	$6,588.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,600.39
Rate for Payer: Cigna Commercial	$10,981.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,588.69
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$529.29
Rate for Payer: Wellpoint Medicaid Managed Care	$582.00

IR PTA PERPHRAL ARTRY OTHER S&

Facility

$21,962.30

Service Code	HCPCS 75962
Hospital Charge Code	2011180
Hospital Revenue Code	320
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

IR PTA PERPHRAL ARTRY OTHER S&

Facility

$21,962.30

Service Code	HCPCS 75962
Hospital Charge Code	7411736
Hospital Revenue Code	320
Min. Negotiated Rate	$529.29
Max. Negotiated Rate	$10,981.15
Rate for Payer: Aetna Commercial	$8,345.67
Rate for Payer: Aetna Medicare Advantage	$6,588.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,600.39
Rate for Payer: Cigna Commercial	$10,981.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,588.69
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$529.29
Rate for Payer: Wellpoint Medicaid Managed Care	$582.00

IR PTA RENAL OR VISCERAL EA AD

Facility

$2,282.45

Service Code	HCPCS 75968
Hospital Charge Code	7411740
Hospital Revenue Code	320
Min. Negotiated Rate	$342.37
Max. Negotiated Rate	$342.37
Rate for Payer: Qualcare PPO/HMO/WC	$342.37

IR PTA RENAL OR VISCERAL EA AD

Facility

$2,282.45

Service Code	HCPCS 75968
Hospital Charge Code	2011288
Hospital Revenue Code	320
Min. Negotiated Rate	$342.37
Max. Negotiated Rate	$342.37
Rate for Payer: Qualcare PPO/HMO/WC	$342.37

IR PTA RENAL OR VISCERAL EA AD

Facility

$2,282.45

Service Code	HCPCS 75968
Hospital Charge Code	2011288
Hospital Revenue Code	320
Min. Negotiated Rate	$55.01
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$867.33
Rate for Payer: Aetna Medicare Advantage	$684.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$582.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$582.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$582.02
Rate for Payer: Cigna Commercial	$1,141.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$684.74
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$342.37
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$55.01
Rate for Payer: Wellpoint Medicaid Managed Care	$60.48

IR PTA RENAL OR VISCERAL EA AD

Facility

$2,282.45

Service Code	HCPCS 75968
Hospital Charge Code	7411740
Hospital Revenue Code	320
Min. Negotiated Rate	$55.01
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$867.33
Rate for Payer: Aetna Medicare Advantage	$684.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$582.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$582.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$582.02
Rate for Payer: Cigna Commercial	$1,141.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$684.74
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$342.37
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$55.01
Rate for Payer: Wellpoint Medicaid Managed Care	$60.48

IR PTA RENAL OR VISCERAL INIT

Facility

$21,962.30

Service Code	HCPCS 75966
Hospital Charge Code	5100355
Hospital Revenue Code	320
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

IR PTA RENAL OR VISCERAL INIT

Facility

$21,962.30

Service Code	HCPCS 75966
Hospital Charge Code	7411739
Hospital Revenue Code	320
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

IR PTA RENAL OR VISCERAL INIT

Facility

$21,962.30

Service Code	HCPCS 75966
Hospital Charge Code	5100355
Hospital Revenue Code	320
Min. Negotiated Rate	$529.29
Max. Negotiated Rate	$10,981.15
Rate for Payer: Aetna Commercial	$8,345.67
Rate for Payer: Aetna Medicare Advantage	$6,588.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,600.39
Rate for Payer: Cigna Commercial	$10,981.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,588.69
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$529.29
Rate for Payer: Wellpoint Medicaid Managed Care	$582.00

IR PTA RENAL OR VISCERAL INIT

Facility

$21,962.30

Service Code	HCPCS 75966
Hospital Charge Code	7411739
Hospital Revenue Code	320
Min. Negotiated Rate	$529.29
Max. Negotiated Rate	$10,981.15
Rate for Payer: Aetna Commercial	$8,345.67
Rate for Payer: Aetna Medicare Advantage	$6,588.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,600.39
Rate for Payer: Cigna Commercial	$10,981.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,588.69
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$529.29
Rate for Payer: Wellpoint Medicaid Managed Care	$582.00

IR-PTA TIBIO ARTERY & BRANCHES

Facility

$10,595.00

Service Code	HCPCS 35470
Hospital Charge Code	2680150
Hospital Revenue Code	361
Min. Negotiated Rate	$1,589.25
Max. Negotiated Rate	$1,589.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,589.25

IR-PTA TIBIO ARTERY & BRANCHES

Facility

$10,595.00

Service Code	HCPCS 35470
Hospital Charge Code	2680150
Hospital Revenue Code	361
Min. Negotiated Rate	$255.34
Max. Negotiated Rate	$5,297.50
Rate for Payer: Aetna Commercial	$4,026.10
Rate for Payer: Aetna Medicare Advantage	$3,178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,701.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,701.72
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	$2,701.72
Rate for Payer: Cigna Commercial	$5,297.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,178.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,589.25
Rate for Payer: UnitedHealthcare Community & State	$255.34
Rate for Payer: Wellpoint Medicaid Managed Care	$280.77

IR PTA VENOUS

Facility

$21,962.30

Service Code	HCPCS 35476
Hospital Charge Code	7411410
Hospital Revenue Code	361
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

IR PTA VENOUS

Facility

$21,962.30

Service Code	HCPCS 35476
Hospital Charge Code	2011173
Hospital Revenue Code	361
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

Know your out-of-pocket cost for care.

All Charges