Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

REVSC EVASC IVT STENT SF 1ST

Facility

$61,616.39

Service Code	HCPCS 37258
Hospital Charge Code	404637258
Hospital Revenue Code	481
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

REVSC EVASC IVT STENT SF 1ST

Facility

$61,616.39

Service Code	HCPCS 37258
Hospital Charge Code	404637258
Hospital Revenue Code	481
Min. Negotiated Rate	$1,484.95
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	$3,194.00
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	$18,484.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,484.95
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	$1,632.83

REVSC EVASC IVT STENT SF 1ST

Facility

$61,616.39

Service Code	HCPCS 37258
Hospital Charge Code	403437258
Hospital Revenue Code	481
Min. Negotiated Rate	$1,484.95
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	$3,194.00
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	$18,484.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,484.95
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	$1,632.83

REVSC EVASC IVT STENT SF 1ST

Facility

$61,616.39

Service Code	HCPCS 37258
Hospital Charge Code	403437258
Hospital Revenue Code	481
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

REVSC EVASC IVT STENT SF EA

Facility

$15,877.00

Service Code	HCPCS 37259
Hospital Charge Code	403437259
Hospital Revenue Code	481
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	$3,194.00
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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
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

REVSC EVASC IVT STENT SF EA

Facility

$15,877.00

Service Code	HCPCS 37259
Hospital Charge Code	403437259
Hospital Revenue Code	481
Min. Negotiated Rate	$2,381.55
Max. Negotiated Rate	$2,381.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

REVSC EVASC IVT STENT SF EA

Facility

$15,877.00

Service Code	HCPCS 37259
Hospital Charge Code	404637259
Hospital Revenue Code	481
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	$3,194.00
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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
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

REVSC EVASC IVT STENT SF EA

Facility

$15,877.00

Service Code	HCPCS 37259
Hospital Charge Code	404637259
Hospital Revenue Code	481
Min. Negotiated Rate	$2,381.55
Max. Negotiated Rate	$2,381.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

REVSC EVASC TPVT ST CPLX 1stLT

Facility

$108,892.35

Service Code	HCPCS 37286
Hospital Charge Code	404637286
Hospital Revenue Code	481
Min. Negotiated Rate	$16,333.85
Max. Negotiated Rate	$16,333.85
Rate for Payer: Qualcare PPO/HMO/WC	$16,333.85

REVSC EVASC TPVT ST CPLX 1stLT

Facility

$108,892.35

Service Code	HCPCS 37286
Hospital Charge Code	404637286
Hospital Revenue Code	481
Min. Negotiated Rate	$2,624.31
Max. Negotiated Rate	$78,613.74
Rate for Payer: Aetna Commercial	$59,237.44
Rate for Payer: Aetna Medicare Advantage	$70,562.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78,613.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78,613.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,778.47
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	$78,613.74
Rate for Payer: Cigna Commercial	$43,654.87
Rate for Payer: Cigna Medicare Advantage	$21,778.47
Rate for Payer: Clover Medicare Advantage	$20,689.55
Rate for Payer: EmblemHealth Commercial	$65,335.41
Rate for Payer: Humana Medicare Advantage	$22,431.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,778.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32,667.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$16,333.85
Rate for Payer: UnitedHealthcare Community & State	$2,624.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,778.47
Rate for Payer: Wellcare Medicare Advantage	$21,778.47
Rate for Payer: Wellpoint Medicaid Managed Care	$2,885.65

REVSC EVSC FPVT ANGIO CPLX 1

Facility

$25,423.30

Service Code	HCPCS 37265
Hospital Charge Code	404637265
Hospital Revenue Code	481
Min. Negotiated Rate	$3,813.49
Max. Negotiated Rate	$3,813.49
Rate for Payer: Qualcare PPO/HMO/WC	$3,813.49

REVSC EVSC FPVT ANGIO CPLX 1

Facility

$25,423.30

Service Code	HCPCS 37265
Hospital Charge Code	404637265
Hospital Revenue Code	481
Min. Negotiated Rate	$612.70
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	$3,194.00
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	$7,626.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,813.49
Rate for Payer: UnitedHealthcare Community & State	$612.70
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	$673.72

REVSC EVSC FPVT ANGIO CPLX 1

Facility

$25,423.30

Service Code	HCPCS 37265
Hospital Charge Code	403437265
Hospital Revenue Code	481
Min. Negotiated Rate	$3,813.49
Max. Negotiated Rate	$3,813.49
Rate for Payer: Qualcare PPO/HMO/WC	$3,813.49

REVSC EVSC FPVT ANGIO CPLX 1

Facility

$25,423.30

Service Code	HCPCS 37265
Hospital Charge Code	403437265
Hospital Revenue Code	481
Min. Negotiated Rate	$612.70
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	$3,194.00
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	$7,626.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,813.49
Rate for Payer: UnitedHealthcare Community & State	$612.70
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	$673.72

REVSC EVSC FPVT ARTRC

Facility

$13,476.50

Service Code	HCPCS 37272
Hospital Charge Code	404637272
Hospital Revenue Code	481
Min. Negotiated Rate	$2,021.47
Max. Negotiated Rate	$2,021.47
Rate for Payer: Qualcare PPO/HMO/WC	$2,021.47

REVSC EVSC FPVT ARTRC

Facility

$13,476.50

Service Code	HCPCS 37272
Hospital Charge Code	404637272
Hospital Revenue Code	481
Min. Negotiated Rate	$324.78
Max. Negotiated Rate	$6,738.25
Rate for Payer: Aetna Commercial	$5,121.07
Rate for Payer: Aetna Medicare Advantage	$4,042.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,436.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,436.51
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	$3,436.51
Rate for Payer: Cigna Commercial	$6,738.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,042.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,021.47
Rate for Payer: UnitedHealthcare Community & State	$324.78
Rate for Payer: Wellpoint Medicaid Managed Care	$357.13

REVSC EVSC FPVT ATHRC SF 1ST

Facility

$52,548.60

Service Code	HCPCS 37271
Hospital Charge Code	403437271
Hospital Revenue Code	481
Min. Negotiated Rate	$1,266.42
Max. Negotiated Rate	$78,613.74
Rate for Payer: Aetna Commercial	$59,237.44
Rate for Payer: Aetna Medicare Advantage	$70,562.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78,613.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78,613.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,778.47
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	$78,613.74
Rate for Payer: Cigna Commercial	$43,654.87
Rate for Payer: Cigna Medicare Advantage	$21,778.47
Rate for Payer: Clover Medicare Advantage	$20,689.55
Rate for Payer: EmblemHealth Commercial	$65,335.41
Rate for Payer: Humana Medicare Advantage	$22,431.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,778.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,764.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,882.29
Rate for Payer: UnitedHealthcare Community & State	$1,266.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,778.47
Rate for Payer: Wellcare Medicare Advantage	$21,778.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1,392.54

REVSC EVSC FPVT ATHRC SF 1ST

Facility

$52,548.60

Service Code	HCPCS 37271
Hospital Charge Code	403437271
Hospital Revenue Code	481
Min. Negotiated Rate	$7,882.29
Max. Negotiated Rate	$7,882.29
Rate for Payer: Qualcare PPO/HMO/WC	$7,882.29

REVSC EVSC FPVT ATHRC SF 1ST

Facility

$52,548.60

Service Code	HCPCS 37271
Hospital Charge Code	404637271
Hospital Revenue Code	481
Min. Negotiated Rate	$7,882.29
Max. Negotiated Rate	$7,882.29
Rate for Payer: Qualcare PPO/HMO/WC	$7,882.29

REVSC EVSC FPVT ATHRC SF 1ST

Facility

$52,548.60

Service Code	HCPCS 37271
Hospital Charge Code	404637271
Hospital Revenue Code	481
Min. Negotiated Rate	$1,266.42
Max. Negotiated Rate	$78,613.74
Rate for Payer: Aetna Commercial	$59,237.44
Rate for Payer: Aetna Medicare Advantage	$70,562.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78,613.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78,613.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,778.47
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	$78,613.74
Rate for Payer: Cigna Commercial	$43,654.87
Rate for Payer: Cigna Medicare Advantage	$21,778.47
Rate for Payer: Clover Medicare Advantage	$20,689.55
Rate for Payer: EmblemHealth Commercial	$65,335.41
Rate for Payer: Humana Medicare Advantage	$22,431.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,778.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,764.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,882.29
Rate for Payer: UnitedHealthcare Community & State	$1,266.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,778.47
Rate for Payer: Wellcare Medicare Advantage	$21,778.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1,392.54

REVSC EVSC FPVT STENTSF 1ST LT

Facility

$52,548.60

Service Code	HCPCS 37267
Hospital Charge Code	4046372671
Hospital Revenue Code	481
Min. Negotiated Rate	$1,266.42
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	$3,194.00
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	$15,764.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,882.29
Rate for Payer: UnitedHealthcare Community & State	$1,266.42
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	$1,392.54

REVSC EVSC FPVT STENTSF 1ST LT

Facility

$52,548.60

Service Code	HCPCS 37267
Hospital Charge Code	4046372671
Hospital Revenue Code	481
Min. Negotiated Rate	$7,882.29
Max. Negotiated Rate	$7,882.29
Rate for Payer: Qualcare PPO/HMO/WC	$7,882.29

REVSC EVSC FPVT STENTSF 1ST RT

Facility

$52,548.60

Service Code	HCPCS 37267
Hospital Charge Code	404637267
Hospital Revenue Code	481
Min. Negotiated Rate	$1,266.42
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	$3,194.00
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	$15,764.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,882.29
Rate for Payer: UnitedHealthcare Community & State	$1,266.42
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	$1,392.54

REVSC EVSC FPVT STENTSF 1ST RT

Facility

$52,548.60

Service Code	HCPCS 37267
Hospital Charge Code	404637267
Hospital Revenue Code	481
Min. Negotiated Rate	$7,882.29
Max. Negotiated Rate	$7,882.29
Rate for Payer: Qualcare PPO/HMO/WC	$7,882.29

REVSC EVSC IVT ANGIO CPLX EA

Facility

$24,441.40

Service Code	HCPCS 37257
Hospital Charge Code	404637257
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

Know your out-of-pocket cost for care.

All Charges