Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TIB REVASC STENT ATHER-LT

Facility

$93,917.89

Service Code	HCPCS 37231LT
Hospital Charge Code	7411940
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-LT

Facility

$93,917.89

Service Code	HCPCS 37231LT
Hospital Charge Code	2691440
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-LT

Facility

$93,917.89

Service Code	HCPCS 37231LT
Hospital Charge Code	2691440
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-LT

Facility

$93,917.89

Service Code	HCPCS 37231LT
Hospital Charge Code	321037231L
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-LT

Facility

$93,917.89

Service Code	HCPCS 37231LT
Hospital Charge Code	366837231L
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-LT

Facility

$93,917.89

Service Code	HCPCS 37231LT
Hospital Charge Code	366837231L
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-LT

Facility

$93,917.89

Service Code	HCPCS 37231LT
Hospital Charge Code	321037231L
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-LT

Facility

$93,917.89

Service Code	HCPCS 37231LT
Hospital Charge Code	7411940
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-RT

Facility

$58,376.00

Service Code	HCPCS 37231RT
Hospital Charge Code	7411941
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

TIB REVASC STENT ATHER-RT

Facility

$93,917.89

Service Code	HCPCS 37231RT
Hospital Charge Code	2691445
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-RT

Facility

$93,917.89

Service Code	HCPCS 37231RT
Hospital Charge Code	2691445
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-RT

Facility

$93,917.89

Service Code	HCPCS 37231RT
Hospital Charge Code	321037231R
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-RT

Facility

$93,917.89

Service Code	HCPCS 37231RT
Hospital Charge Code	321037231R
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-RT

Facility

$58,376.00

Service Code	HCPCS 37231RT
Hospital Charge Code	7411941
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-RT

Facility

$93,917.89

Service Code	HCPCS 37231RT
Hospital Charge Code	366837231R
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-RT

Facility

$93,917.89

Service Code	HCPCS 37231RT
Hospital Charge Code	366837231R
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-RT

Facility

$93,917.89

Service Code	HCPCS 37292RT
Hospital Charge Code	411037231
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-RT

Facility

$93,917.89

Service Code	HCPCS 37292RT
Hospital Charge Code	411037231
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&SCRW AUG BLK11MM LLAT/RMED

Facility

$3,860.00

Service Code	HCPCS C1713
Hospital Charge Code	270680668
Hospital Revenue Code	278
Min. Negotiated Rate	$579.00
Max. Negotiated Rate	$934.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$849.20
Rate for Payer: Qualcare PPO/HMO/WC	$579.00

TIB&SCRW AUG BLK11MM LLAT/RMED

Facility

$3,860.00

Service Code	HCPCS C1713
Hospital Charge Code	270680668
Hospital Revenue Code	278
Min. Negotiated Rate	$93.03
Max. Negotiated Rate	$1,930.00
Rate for Payer: Aetna Commercial	$1,466.80
Rate for Payer: Aetna Medicare Advantage	$1,158.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$984.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$984.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$984.30
Rate for Payer: Cigna Commercial	$1,930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$849.20
Rate for Payer: Qualcare PPO/HMO/WC	$579.00
Rate for Payer: UnitedHealthcare Community & State	$93.03
Rate for Payer: Wellpoint Medicaid Managed Care	$102.29

TIB&SCRW AUG BLK11MM RLAT/LMED

Facility

$3,861.00

Service Code	HCPCS C1713
Hospital Charge Code	270680669
Hospital Revenue Code	278
Min. Negotiated Rate	$93.05
Max. Negotiated Rate	$1,930.50
Rate for Payer: Aetna Commercial	$1,467.18
Rate for Payer: Aetna Medicare Advantage	$1,158.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$984.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$984.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$984.55
Rate for Payer: Cigna Commercial	$1,930.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$849.42
Rate for Payer: Qualcare PPO/HMO/WC	$579.15
Rate for Payer: UnitedHealthcare Community & State	$93.05
Rate for Payer: Wellpoint Medicaid Managed Care	$102.32

TIB&SCRW AUG BLK11MM RLAT/LMED

Facility

$3,861.00

Service Code	HCPCS C1713
Hospital Charge Code	270680669
Hospital Revenue Code	278
Min. Negotiated Rate	$579.15
Max. Negotiated Rate	$934.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$849.42
Rate for Payer: Qualcare PPO/HMO/WC	$579.15

TI CAGE 9MM MEDIUM

Facility

$10,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705744
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

TI CAGE 9MM MEDIUM

Facility

$10,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705744
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

TICAGRELOR 90MG TAB

Facility

$36.45

Service Code	NDC 186077739
Hospital Charge Code	60630216
Hospital Revenue Code	250
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$18.23
Rate for Payer: Aetna Commercial	$13.85
Rate for Payer: Aetna Medicare Advantage	$10.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.29
Rate for Payer: Cigna Commercial	$18.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.94
Rate for Payer: Oxford Commercial	$7.29
Rate for Payer: Qualcare PPO/HMO/WC	$5.47
Rate for Payer: UnitedHealthcare Commercial	$7.29
Rate for Payer: UnitedHealthcare Community & State	$0.88
Rate for Payer: Wellpoint Medicaid Managed Care	$0.97

Know your out-of-pocket cost for care.

All Charges