Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TIB/PR ATHRCTMY ADD EA-BI

Facility

$33,707.00

Service Code	HCPCS 3723350
Hospital Charge Code	411037233
Hospital Revenue Code	361
Min. Negotiated Rate	$812.34
Max. Negotiated Rate	$16,853.50
Rate for Payer: Aetna Commercial	$12,808.66
Rate for Payer: Aetna Medicare Advantage	$10,112.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,595.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,595.28
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	$8,595.28
Rate for Payer: Cigna Commercial	$16,853.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,112.10
Rate for Payer: Qualcare PPO/HMO/WC	$5,056.05
Rate for Payer: UnitedHealthcare Community & State	$812.34
Rate for Payer: Wellpoint Medicaid Managed Care	$893.24

TIB/PR ATHRCTMY ADD EA-BI

Facility

$33,707.00

Service Code	HCPCS 3723350
Hospital Charge Code	321037233B
Hospital Revenue Code	361
Min. Negotiated Rate	$5,056.05
Max. Negotiated Rate	$5,056.05
Rate for Payer: Qualcare PPO/HMO/WC	$5,056.05

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	$5,356.05
Max. Negotiated Rate	$5,356.05
Rate for Payer: Qualcare PPO/HMO/WC	$5,356.05

TIB/PR ATHRCTMY ADD EA-BI

Facility

$33,707.00

Service Code	HCPCS 3723350
Hospital Charge Code	411037233
Hospital Revenue Code	361
Min. Negotiated Rate	$5,056.05
Max. Negotiated Rate	$5,056.05
Rate for Payer: Qualcare PPO/HMO/WC	$5,056.05

TIB/PR ATHRCTMY ADD EA-BI

Facility

$33,707.00

Service Code	HCPCS 3723350
Hospital Charge Code	2690565
Hospital Revenue Code	361
Min. Negotiated Rate	$5,056.05
Max. Negotiated Rate	$5,056.05
Rate for Payer: Qualcare PPO/HMO/WC	$5,056.05

TIB/PR ATHRCTMY ADD EA-BI

Facility

$33,707.00

Service Code	HCPCS 3723350
Hospital Charge Code	2690565
Hospital Revenue Code	361
Min. Negotiated Rate	$812.34
Max. Negotiated Rate	$16,853.50
Rate for Payer: Aetna Commercial	$12,808.66
Rate for Payer: Aetna Medicare Advantage	$10,112.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,595.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,595.28
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	$8,595.28
Rate for Payer: Cigna Commercial	$16,853.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,112.10
Rate for Payer: Qualcare PPO/HMO/WC	$5,056.05
Rate for Payer: UnitedHealthcare Community & State	$812.34
Rate for Payer: Wellpoint Medicaid Managed Care	$893.24

TIB/PR ATHRCTMY ADD EA-BI

Facility

$33,707.00

Service Code	HCPCS 3723350
Hospital Charge Code	7411812
Hospital Revenue Code	361
Min. Negotiated Rate	$5,056.05
Max. Negotiated Rate	$5,056.05
Rate for Payer: Qualcare PPO/HMO/WC	$5,056.05

TIB/PR ATHRCTMY ADD EA-BI

Facility

$33,707.00

Service Code	HCPCS 3723350
Hospital Charge Code	7411812
Hospital Revenue Code	361
Min. Negotiated Rate	$812.34
Max. Negotiated Rate	$16,853.50
Rate for Payer: Aetna Commercial	$12,808.66
Rate for Payer: Aetna Medicare Advantage	$10,112.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,595.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,595.28
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	$8,595.28
Rate for Payer: Cigna Commercial	$16,853.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,112.10
Rate for Payer: Qualcare PPO/HMO/WC	$5,056.05
Rate for Payer: UnitedHealthcare Community & State	$812.34
Rate for Payer: Wellpoint Medicaid Managed Care	$893.24

TIB/PR ATHRCTMY ADD EA-BI

Facility

$33,707.00

Service Code	HCPCS 3723350
Hospital Charge Code	321037233B
Hospital Revenue Code	361
Min. Negotiated Rate	$812.34
Max. Negotiated Rate	$16,853.50
Rate for Payer: Aetna Commercial	$12,808.66
Rate for Payer: Aetna Medicare Advantage	$10,112.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,595.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,595.28
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	$8,595.28
Rate for Payer: Cigna Commercial	$16,853.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,112.10
Rate for Payer: Qualcare PPO/HMO/WC	$5,056.05
Rate for Payer: UnitedHealthcare Community & State	$812.34
Rate for Payer: Wellpoint Medicaid Managed Care	$893.24

TIB/PR ATHRCTMY ADD EA-LT

Facility

$33,707.00

Service Code	HCPCS 37233LT
Hospital Charge Code	7411944
Hospital Revenue Code	361
Min. Negotiated Rate	$5,056.05
Max. Negotiated Rate	$5,056.05
Rate for Payer: Qualcare PPO/HMO/WC	$5,056.05

TIB/PR ATHRCTMY ADD EA-LT

Facility

$33,707.00

Service Code	HCPCS 37233LT
Hospital Charge Code	7411944
Hospital Revenue Code	361
Min. Negotiated Rate	$812.34
Max. Negotiated Rate	$16,853.50
Rate for Payer: Aetna Commercial	$12,808.66
Rate for Payer: Aetna Medicare Advantage	$10,112.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,595.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,595.28
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	$8,595.28
Rate for Payer: Cigna Commercial	$16,853.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,112.10
Rate for Payer: Qualcare PPO/HMO/WC	$5,056.05
Rate for Payer: UnitedHealthcare Community & State	$812.34
Rate for Payer: Wellpoint Medicaid Managed Care	$893.24

TIB/PR ATHRCTMY ADD EA-LT

Facility

$33,707.00

Service Code	HCPCS 37233LT
Hospital Charge Code	2691460
Hospital Revenue Code	361
Min. Negotiated Rate	$812.34
Max. Negotiated Rate	$16,853.50
Rate for Payer: Aetna Commercial	$12,808.66
Rate for Payer: Aetna Medicare Advantage	$10,112.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,595.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,595.28
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	$8,595.28
Rate for Payer: Cigna Commercial	$16,853.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,112.10
Rate for Payer: Qualcare PPO/HMO/WC	$5,056.05
Rate for Payer: UnitedHealthcare Community & State	$812.34
Rate for Payer: Wellpoint Medicaid Managed Care	$893.24

TIB/PR ATHRCTMY ADD EA-LT

Facility

$33,707.00

Service Code	HCPCS 37233LT
Hospital Charge Code	2691460
Hospital Revenue Code	361
Min. Negotiated Rate	$5,056.05
Max. Negotiated Rate	$5,056.05
Rate for Payer: Qualcare PPO/HMO/WC	$5,056.05

TIB/PR ATHRCTMY ADD EA-RT

Facility

$33,707.00

Service Code	HCPCS 37233RT
Hospital Charge Code	7411945
Hospital Revenue Code	361
Min. Negotiated Rate	$812.34
Max. Negotiated Rate	$16,853.50
Rate for Payer: Aetna Commercial	$12,808.66
Rate for Payer: Aetna Medicare Advantage	$10,112.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,595.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,595.28
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	$8,595.28
Rate for Payer: Cigna Commercial	$16,853.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,112.10
Rate for Payer: Qualcare PPO/HMO/WC	$5,056.05
Rate for Payer: UnitedHealthcare Community & State	$812.34
Rate for Payer: Wellpoint Medicaid Managed Care	$893.24

TIB/PR ATHRCTMY ADD EA-RT

Facility

$33,707.00

Service Code	HCPCS 37233RT
Hospital Charge Code	321037233R
Hospital Revenue Code	361
Min. Negotiated Rate	$5,056.05
Max. Negotiated Rate	$5,056.05
Rate for Payer: Qualcare PPO/HMO/WC	$5,056.05

TIB/PR ATHRCTMY ADD EA-RT

Facility

$33,707.00

Service Code	HCPCS 37233RT
Hospital Charge Code	7411945
Hospital Revenue Code	361
Min. Negotiated Rate	$5,056.05
Max. Negotiated Rate	$5,056.05
Rate for Payer: Qualcare PPO/HMO/WC	$5,056.05

TIB/PR ATHRCTMY ADD EA-RT

Facility

$33,707.00

Service Code	HCPCS 37233RT
Hospital Charge Code	2691465
Hospital Revenue Code	361
Min. Negotiated Rate	$5,056.05
Max. Negotiated Rate	$5,056.05
Rate for Payer: Qualcare PPO/HMO/WC	$5,056.05

TIB/PR ATHRCTMY ADD EA-RT

Facility

$33,707.00

Service Code	HCPCS 37233RT
Hospital Charge Code	2691465
Hospital Revenue Code	361
Min. Negotiated Rate	$812.34
Max. Negotiated Rate	$16,853.50
Rate for Payer: Aetna Commercial	$12,808.66
Rate for Payer: Aetna Medicare Advantage	$10,112.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,595.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,595.28
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	$8,595.28
Rate for Payer: Cigna Commercial	$16,853.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,112.10
Rate for Payer: Qualcare PPO/HMO/WC	$5,056.05
Rate for Payer: UnitedHealthcare Community & State	$812.34
Rate for Payer: Wellpoint Medicaid Managed Care	$893.24

TIB/PR ATHRCTMY ADD EA-RT

Facility

$33,707.00

Service Code	HCPCS 37233RT
Hospital Charge Code	321037233R
Hospital Revenue Code	361
Min. Negotiated Rate	$812.34
Max. Negotiated Rate	$16,853.50
Rate for Payer: Aetna Commercial	$12,808.66
Rate for Payer: Aetna Medicare Advantage	$10,112.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,595.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,595.28
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	$8,595.28
Rate for Payer: Cigna Commercial	$16,853.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,112.10
Rate for Payer: Qualcare PPO/HMO/WC	$5,056.05
Rate for Payer: UnitedHealthcare Community & State	$812.34
Rate for Payer: Wellpoint Medicaid Managed Care	$893.24

TIB PSN POR PEG SZ D

Facility

$13,830.00

Service Code	HCPCS C1776
Hospital Charge Code	270693242
Hospital Revenue Code	278
Min. Negotiated Rate	$333.30
Max. Negotiated Rate	$6,915.00
Rate for Payer: Aetna Commercial	$5,255.40
Rate for Payer: Aetna Medicare Advantage	$4,149.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,526.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,526.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,766.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,526.65
Rate for Payer: Cigna Commercial	$6,915.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,346.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,042.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,074.50
Rate for Payer: UnitedHealthcare Community & State	$333.30
Rate for Payer: Wellpoint Medicaid Managed Care	$366.50

TIB PSN POR PEG SZ D

Facility

$13,830.00

Service Code	HCPCS C1776
Hospital Charge Code	270693242
Hospital Revenue Code	278
Min. Negotiated Rate	$2,074.50
Max. Negotiated Rate	$3,346.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,766.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,346.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,042.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,074.50

TIB REVASC STENT ATHER-BI

Facility

$93,917.89

Service Code	HCPCS 3723150
Hospital Charge Code	7411810
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 REVASC STENT ATHER-BI

Facility

$93,917.89

Service Code	HCPCS 3723150
Hospital Charge Code	7411810
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 REVASC STENT ATHER-BI

Facility

$58,376.00

Service Code	HCPCS 3723150
Hospital Charge Code	2690555
Hospital Revenue Code	361
Min. Negotiated Rate	$8,756.40
Max. Negotiated Rate	$8,756.40
Rate for Payer: Qualcare PPO/HMO/WC	$8,756.40

TIB REVASC STENT ATHER-BI

Facility

$58,376.00

Service Code	HCPCS 3723150
Hospital Charge Code	2690555
Hospital Revenue Code	361
Min. Negotiated Rate	$1,406.86
Max. Negotiated Rate	$29,188.00
Rate for Payer: Aetna Commercial	$22,182.88
Rate for Payer: Aetna Medicare Advantage	$17,512.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,885.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,885.88
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	$14,885.88
Rate for Payer: Cigna Commercial	$29,188.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17,512.80
Rate for Payer: Qualcare PPO/HMO/WC	$8,756.40
Rate for Payer: UnitedHealthcare Community & State	$1,406.86
Rate for Payer: Wellpoint Medicaid Managed Care	$1,546.96

Know your out-of-pocket cost for care.

All Charges