Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DX-CHEST SINGLE VIEW

Facility

$582.98

Hospital Charge Code	4509001
Hospital Revenue Code	324
Min. Negotiated Rate	$87.45
Max. Negotiated Rate	$87.45
Rate for Payer: Qualcare PPO/HMO/WC	$87.45

DX-CHEST SINGLE VIEW

Facility

$582.98

Hospital Charge Code	4509001
Hospital Revenue Code	324
Min. Negotiated Rate	$14.05
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$221.53
Rate for Payer: Aetna Medicare Advantage	$174.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$148.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$148.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$148.66
Rate for Payer: Cigna Commercial	$291.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.89
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$87.45
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$14.05
Rate for Payer: Wellpoint Medicaid Managed Care	$15.45

DX-CLAVICLE LT

Facility

$327.00

Service Code	HCPCS 73000
Hospital Charge Code	2008010
Hospital Revenue Code	320
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$373.21
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$72.37
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.10
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.05
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$7.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59
Rate for Payer: Wellpoint Medicaid Managed Care	$8.67

DX-CLAVICLE LT

Facility

$327.00

Service Code	HCPCS 73000
Hospital Charge Code	2008010
Hospital Revenue Code	320
Min. Negotiated Rate	$49.05
Max. Negotiated Rate	$49.05
Rate for Payer: Qualcare PPO/HMO/WC	$49.05

DX-DIL OF BILIAR W/O STNT

Facility

$2,977.00

Hospital Charge Code	2009345
Hospital Revenue Code	320
Min. Negotiated Rate	$71.75
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,131.26
Rate for Payer: Aetna Medicare Advantage	$893.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$759.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$759.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$759.13
Rate for Payer: Cigna Commercial	$1,488.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$893.10
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$446.55
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$71.75
Rate for Payer: Wellpoint Medicaid Managed Care	$78.89

DX-DIL OF BILIAR W/O STNT

Facility

$2,977.00

Hospital Charge Code	2009345
Hospital Revenue Code	320
Min. Negotiated Rate	$446.55
Max. Negotiated Rate	$446.55
Rate for Payer: Qualcare PPO/HMO/WC	$446.55

DX-DIL OF NEPHROSTOMY-BI

Facility

$10,187.80

Service Code	HCPCS 7448550
Hospital Charge Code	411074485B
Hospital Revenue Code	320
Min. Negotiated Rate	$1,528.17
Max. Negotiated Rate	$1,528.17
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17

DX-DIL OF NEPHROSTOMY-BI

Facility

$10,187.80

Service Code	HCPCS 7448550
Hospital Charge Code	2690730
Hospital Revenue Code	320
Min. Negotiated Rate	$1,528.17
Max. Negotiated Rate	$1,528.17
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17

DX-DIL OF NEPHROSTOMY-BI

Facility

$10,187.80

Service Code	HCPCS 7448550
Hospital Charge Code	321074485B
Hospital Revenue Code	320
Min. Negotiated Rate	$1,528.17
Max. Negotiated Rate	$1,528.17
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17

DX-DIL OF NEPHROSTOMY-BI

Facility

$5,055.00

Service Code	HCPCS 7448550
Hospital Charge Code	7411837
Hospital Revenue Code	320
Min. Negotiated Rate	$758.25
Max. Negotiated Rate	$758.25
Rate for Payer: Qualcare PPO/HMO/WC	$758.25

DX-DIL OF NEPHROSTOMY-BI

Facility

$10,187.80

Service Code	HCPCS 7448550
Hospital Charge Code	3668744855
Hospital Revenue Code	320
Min. Negotiated Rate	$245.53
Max. Negotiated Rate	$5,093.90
Rate for Payer: Aetna Commercial	$3,871.36
Rate for Payer: Aetna Medicare Advantage	$3,056.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,597.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,597.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,597.89
Rate for Payer: Cigna Commercial	$5,093.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,056.34
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$245.53
Rate for Payer: Wellpoint Medicaid Managed Care	$269.98

DX-DIL OF NEPHROSTOMY-BI

Facility

$10,187.80

Service Code	HCPCS 7448550
Hospital Charge Code	321074485B
Hospital Revenue Code	320
Min. Negotiated Rate	$245.53
Max. Negotiated Rate	$5,093.90
Rate for Payer: Aetna Commercial	$3,871.36
Rate for Payer: Aetna Medicare Advantage	$3,056.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,597.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,597.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,597.89
Rate for Payer: Cigna Commercial	$5,093.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,056.34
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$245.53
Rate for Payer: Wellpoint Medicaid Managed Care	$269.98

DX-DIL OF NEPHROSTOMY-BI

Facility

$10,187.80

Service Code	HCPCS 7448550
Hospital Charge Code	411074485B
Hospital Revenue Code	320
Min. Negotiated Rate	$245.53
Max. Negotiated Rate	$5,093.90
Rate for Payer: Aetna Commercial	$3,871.36
Rate for Payer: Aetna Medicare Advantage	$3,056.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,597.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,597.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,597.89
Rate for Payer: Cigna Commercial	$5,093.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,056.34
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$245.53
Rate for Payer: Wellpoint Medicaid Managed Care	$269.98

DX-DIL OF NEPHROSTOMY-BI

Facility

$10,187.80

Service Code	HCPCS 7448550
Hospital Charge Code	2690730
Hospital Revenue Code	320
Min. Negotiated Rate	$245.53
Max. Negotiated Rate	$5,093.90
Rate for Payer: Aetna Commercial	$3,871.36
Rate for Payer: Aetna Medicare Advantage	$3,056.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,597.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,597.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,597.89
Rate for Payer: Cigna Commercial	$5,093.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,056.34
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$245.53
Rate for Payer: Wellpoint Medicaid Managed Care	$269.98

DX-DIL OF NEPHROSTOMY-BI

Facility

$10,187.80

Service Code	HCPCS 7448550
Hospital Charge Code	3668744855
Hospital Revenue Code	320
Min. Negotiated Rate	$1,528.17
Max. Negotiated Rate	$1,528.17
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17

DX-DIL OF NEPHROSTOMY-BI

Facility

$5,055.00

Service Code	HCPCS 7448550
Hospital Charge Code	7411837
Hospital Revenue Code	320
Min. Negotiated Rate	$121.83
Max. Negotiated Rate	$2,527.50
Rate for Payer: Aetna Commercial	$1,920.90
Rate for Payer: Aetna Medicare Advantage	$1,516.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,289.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,289.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,289.03
Rate for Payer: Cigna Commercial	$2,527.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,516.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$758.25
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$121.83
Rate for Payer: Wellpoint Medicaid Managed Care	$133.96

DX-DIL OF NEPHROSTOMY-LT

Facility

$3,550.00

Service Code	HCPCS 74485LT
Hospital Charge Code	2691800
Hospital Revenue Code	320
Min. Negotiated Rate	$85.56
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,349.00
Rate for Payer: Aetna Medicare Advantage	$1,065.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$905.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$905.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$905.25
Rate for Payer: Cigna Commercial	$1,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,065.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$532.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$85.56
Rate for Payer: Wellpoint Medicaid Managed Care	$94.08

DX-DIL OF NEPHROSTOMY-LT

Facility

$5,055.00

Service Code	HCPCS 74485LT
Hospital Charge Code	7411996
Hospital Revenue Code	320
Min. Negotiated Rate	$121.83
Max. Negotiated Rate	$2,527.50
Rate for Payer: Aetna Commercial	$1,920.90
Rate for Payer: Aetna Medicare Advantage	$1,516.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,289.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,289.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,289.03
Rate for Payer: Cigna Commercial	$2,527.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,516.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$758.25
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$121.83
Rate for Payer: Wellpoint Medicaid Managed Care	$133.96

DX-DIL OF NEPHROSTOMY-LT

Facility

$5,055.00

Service Code	HCPCS 74485LT
Hospital Charge Code	7411996
Hospital Revenue Code	320
Min. Negotiated Rate	$758.25
Max. Negotiated Rate	$758.25
Rate for Payer: Qualcare PPO/HMO/WC	$758.25

DX-DIL OF NEPHROSTOMY-LT

Facility

$3,550.00

Service Code	HCPCS 74485LT
Hospital Charge Code	2691800
Hospital Revenue Code	320
Min. Negotiated Rate	$532.50
Max. Negotiated Rate	$532.50
Rate for Payer: Qualcare PPO/HMO/WC	$532.50

DX-DIL OF NEPHROSTOMY-RT

Facility

$10,187.80

Service Code	HCPCS 74485RT
Hospital Charge Code	321074485R
Hospital Revenue Code	320
Min. Negotiated Rate	$245.53
Max. Negotiated Rate	$5,093.90
Rate for Payer: Aetna Commercial	$3,871.36
Rate for Payer: Aetna Medicare Advantage	$3,056.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,597.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,597.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,597.89
Rate for Payer: Cigna Commercial	$5,093.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,056.34
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$245.53
Rate for Payer: Wellpoint Medicaid Managed Care	$269.98

DX-DIL OF NEPHROSTOMY-RT

Facility

$10,187.80

Service Code	HCPCS 74485RT
Hospital Charge Code	411074485
Hospital Revenue Code	320
Min. Negotiated Rate	$245.53
Max. Negotiated Rate	$5,093.90
Rate for Payer: Aetna Commercial	$3,871.36
Rate for Payer: Aetna Medicare Advantage	$3,056.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,597.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,597.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,597.89
Rate for Payer: Cigna Commercial	$5,093.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,056.34
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$245.53
Rate for Payer: Wellpoint Medicaid Managed Care	$269.98

DX-DIL OF NEPHROSTOMY-RT

Facility

$10,187.80

Service Code	HCPCS 74485RT
Hospital Charge Code	2691805
Hospital Revenue Code	320
Min. Negotiated Rate	$245.53
Max. Negotiated Rate	$5,093.90
Rate for Payer: Aetna Commercial	$3,871.36
Rate for Payer: Aetna Medicare Advantage	$3,056.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,597.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,597.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,597.89
Rate for Payer: Cigna Commercial	$5,093.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,056.34
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$245.53
Rate for Payer: Wellpoint Medicaid Managed Care	$269.98

DX-DIL OF NEPHROSTOMY-RT

Facility

$5,055.00

Service Code	HCPCS 74485RT
Hospital Charge Code	7411997
Hospital Revenue Code	320
Min. Negotiated Rate	$758.25
Max. Negotiated Rate	$758.25
Rate for Payer: Qualcare PPO/HMO/WC	$758.25

DX-DIL OF NEPHROSTOMY-RT

Facility

$10,187.80

Service Code	HCPCS 74485RT
Hospital Charge Code	321074485R
Hospital Revenue Code	320
Min. Negotiated Rate	$1,528.17
Max. Negotiated Rate	$1,528.17
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17

Know your out-of-pocket cost for care.

All Charges