Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TIB/PER REVASC W/STENT-BI

Facility

$93,917.89

Service Code	HCPCS 3723050
Hospital Charge Code	7411809
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$35,688.80
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
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	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28,175.37
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68
Rate for Payer: UnitedHealthcare Community & State	$2,263.42
Rate for Payer: Wellpoint Medicaid Managed Care	$2,488.82

TIB/PER REVASC W/STENT-BI

Facility

$93,917.89

Service Code	HCPCS 3723050
Hospital Charge Code	7411809
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB/PER REVASC W/STENT-BI

Facility

$33,710.00

Service Code	HCPCS 3723050
Hospital Charge Code	2690550
Hospital Revenue Code	361
Min. Negotiated Rate	$5,056.50
Max. Negotiated Rate	$5,056.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,056.50

TIB/PER REVASC W/STENT-BI

Facility

$33,710.00

Service Code	HCPCS 3723050
Hospital Charge Code	2690550
Hospital Revenue Code	361
Min. Negotiated Rate	$812.41
Max. Negotiated Rate	$16,855.00
Rate for Payer: Aetna Commercial	$12,809.80
Rate for Payer: Aetna Medicare Advantage	$10,113.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,596.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,596.05
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	$8,596.05
Rate for Payer: Cigna Commercial	$16,855.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,113.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,056.50
Rate for Payer: UnitedHealthcare Community & State	$812.41
Rate for Payer: Wellpoint Medicaid Managed Care	$893.32

TIB/PER REVASC W/STENT-LT

Facility

$93,917.89

Service Code	HCPCS 37230LT
Hospital Charge Code	2691430
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$35,688.80
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
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	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28,175.37
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68
Rate for Payer: UnitedHealthcare Community & State	$2,263.42
Rate for Payer: Wellpoint Medicaid Managed Care	$2,488.82

TIB/PER REVASC W/STENT-LT

Facility

$93,917.89

Service Code	HCPCS 37230LT
Hospital Charge Code	7411938
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$35,688.80
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
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	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28,175.37
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68
Rate for Payer: UnitedHealthcare Community & State	$2,263.42
Rate for Payer: Wellpoint Medicaid Managed Care	$2,488.82

TIB/PER REVASC W/STENT-LT

Facility

$93,917.89

Service Code	HCPCS 37230LT
Hospital Charge Code	2691430
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB/PER REVASC W/STENT-LT

Facility

$93,917.89

Service Code	HCPCS 37230LT
Hospital Charge Code	7411938
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB/PER REVASC W/STENT-LT

Facility

$93,917.89

Service Code	HCPCS 37230LT
Hospital Charge Code	321037230L
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB/PER REVASC W/STENT-LT

Facility

$93,917.89

Service Code	HCPCS 37230LT
Hospital Charge Code	366837230L
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$35,688.80
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
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	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28,175.37
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68
Rate for Payer: UnitedHealthcare Community & State	$2,263.42
Rate for Payer: Wellpoint Medicaid Managed Care	$2,488.82

TIB/PER REVASC W/STENT-LT

Facility

$93,917.89

Service Code	HCPCS 37230LT
Hospital Charge Code	366837230L
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB/PER REVASC W/STENT-LT

Facility

$93,917.89

Service Code	HCPCS 37230LT
Hospital Charge Code	321037230L
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$35,688.80
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
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	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28,175.37
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68
Rate for Payer: UnitedHealthcare Community & State	$2,263.42
Rate for Payer: Wellpoint Medicaid Managed Care	$2,488.82

TIB/PER REVASC W/STENT-RT

Facility

$93,917.89

Service Code	HCPCS 37230RT
Hospital Charge Code	321037230R
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$35,688.80
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
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	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28,175.37
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68
Rate for Payer: UnitedHealthcare Community & State	$2,263.42
Rate for Payer: Wellpoint Medicaid Managed Care	$2,488.82

TIB/PER REVASC W/STENT-RT

Facility

$93,917.89

Service Code	HCPCS 37230RT
Hospital Charge Code	411037230R
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$35,688.80
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
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	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28,175.37
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68
Rate for Payer: UnitedHealthcare Community & State	$2,263.42
Rate for Payer: Wellpoint Medicaid Managed Care	$2,488.82

TIB/PER REVASC W/STENT-RT

Facility

$93,917.89

Service Code	HCPCS 37230RT
Hospital Charge Code	366837230R
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB/PER REVASC W/STENT-RT

Facility

$93,917.89

Service Code	HCPCS 37230RT
Hospital Charge Code	366837230R
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$35,688.80
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
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	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28,175.37
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68
Rate for Payer: UnitedHealthcare Community & State	$2,263.42
Rate for Payer: Wellpoint Medicaid Managed Care	$2,488.82

TIB/PER REVASC W/STENT-RT

Facility

$93,917.89

Service Code	HCPCS 37230RT
Hospital Charge Code	321037230R
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB/PER REVASC W/STENT-RT

Facility

$33,710.00

Service Code	HCPCS 37230RT
Hospital Charge Code	7411939
Hospital Revenue Code	361
Min. Negotiated Rate	$812.41
Max. Negotiated Rate	$16,855.00
Rate for Payer: Aetna Commercial	$12,809.80
Rate for Payer: Aetna Medicare Advantage	$10,113.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,596.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,596.05
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	$8,596.05
Rate for Payer: Cigna Commercial	$16,855.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,113.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,056.50
Rate for Payer: UnitedHealthcare Community & State	$812.41
Rate for Payer: Wellpoint Medicaid Managed Care	$893.32

TIB/PER REVASC W/STENT-RT

Facility

$93,917.89

Service Code	HCPCS 37230RT
Hospital Charge Code	2691435
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB/PER REVASC W/STENT-RT

Facility

$93,917.89

Service Code	HCPCS 37230RT
Hospital Charge Code	411037230R
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB/PER REVASC W/STENT-RT

Facility

$33,710.00

Service Code	HCPCS 37230RT
Hospital Charge Code	7411939
Hospital Revenue Code	361
Min. Negotiated Rate	$5,056.50
Max. Negotiated Rate	$5,056.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,056.50

TIB/PER REVASC W/STENT-RT

Facility

$93,917.89

Service Code	HCPCS 37230RT
Hospital Charge Code	2691435
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$35,688.80
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
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	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28,175.37
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68
Rate for Payer: UnitedHealthcare Community & State	$2,263.42
Rate for Payer: Wellpoint Medicaid Managed Care	$2,488.82

TIB/PER REVASC W/TLA

Facility

$42,041.84

Service Code	HCPCS 37228
Hospital Charge Code	1600000504
Hospital Revenue Code	360
Min. Negotiated Rate	$1,013.21
Max. Negotiated Rate	$21,020.92
Rate for Payer: Aetna Commercial	$15,975.90
Rate for Payer: Aetna Medicare Advantage	$12,612.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,720.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,720.67
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	$10,720.67
Rate for Payer: Cigna Commercial	$21,020.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,612.55
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,306.28
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,013.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1,114.11

TIB/PER REVASC W/TLA

Facility

$42,041.84

Service Code	HCPCS 37228
Hospital Charge Code	1600000504
Hospital Revenue Code	360
Min. Negotiated Rate	$6,306.28
Max. Negotiated Rate	$6,306.28
Rate for Payer: Qualcare PPO/HMO/WC	$6,306.28

TIB/PR ATHRCTMY ADD EA-BI

Facility

$35,707.00

Service Code	HCPCS 3723350
Hospital Charge Code	3668372335
Hospital Revenue Code	361
Min. Negotiated Rate	$860.54
Max. Negotiated Rate	$17,853.50
Rate for Payer: Aetna Commercial	$13,568.66
Rate for Payer: Aetna Medicare Advantage	$10,712.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,105.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,105.28
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	$9,105.28
Rate for Payer: Cigna Commercial	$17,853.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,712.10
Rate for Payer: Qualcare PPO/HMO/WC	$5,356.05
Rate for Payer: UnitedHealthcare Community & State	$860.54
Rate for Payer: Wellpoint Medicaid Managed Care	$946.24

Know your out-of-pocket cost for care.

All Charges