Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DX-PULMONARY SELECTIVE-RT

Facility

$34,050.00

Service Code	HCPCS 75741RT
Hospital Charge Code	2691900
Hospital Revenue Code	320
Min. Negotiated Rate	$820.61
Max. Negotiated Rate	$17,025.00
Rate for Payer: Aetna Commercial	$12,939.00
Rate for Payer: Aetna Medicare Advantage	$10,215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,682.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,682.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,682.75
Rate for Payer: Cigna Commercial	$17,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,215.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,107.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$820.61
Rate for Payer: Wellpoint Medicaid Managed Care	$902.33

DX-PULMONARY SELECTIVE-RT

Facility

$34,050.00

Service Code	HCPCS 75741RT
Hospital Charge Code	7412009
Hospital Revenue Code	320
Min. Negotiated Rate	$820.61
Max. Negotiated Rate	$17,025.00
Rate for Payer: Aetna Commercial	$12,939.00
Rate for Payer: Aetna Medicare Advantage	$10,215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,682.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,682.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,682.75
Rate for Payer: Cigna Commercial	$17,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,215.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,107.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$820.61
Rate for Payer: Wellpoint Medicaid Managed Care	$902.33

DX-PULMONARY SELECTIVE-RT

Facility

$34,050.00

Service Code	HCPCS 75741RT
Hospital Charge Code	7412009
Hospital Revenue Code	320
Min. Negotiated Rate	$5,107.50
Max. Negotiated Rate	$5,107.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,107.50

DX-PULMONARY SELECTIVE-RT

Facility

$34,050.00

Service Code	HCPCS 75741RT
Hospital Charge Code	321075741R
Hospital Revenue Code	320
Min. Negotiated Rate	$820.61
Max. Negotiated Rate	$17,025.00
Rate for Payer: Aetna Commercial	$12,939.00
Rate for Payer: Aetna Medicare Advantage	$10,215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,682.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,682.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,682.75
Rate for Payer: Cigna Commercial	$17,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,215.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,107.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$820.61
Rate for Payer: Wellpoint Medicaid Managed Care	$902.33

DX-PULMONARY SELECTIVE-RT

Facility

$34,050.00

Service Code	HCPCS 75741RT
Hospital Charge Code	321075741R
Hospital Revenue Code	320
Min. Negotiated Rate	$5,107.50
Max. Negotiated Rate	$5,107.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,107.50

DX-PULMONARY SELECTIVE-RT

Facility

$34,050.00

Service Code	HCPCS 75741RT
Hospital Charge Code	2691900
Hospital Revenue Code	320
Min. Negotiated Rate	$5,107.50
Max. Negotiated Rate	$5,107.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,107.50

DX-RENAL ATHERECTOMY-BI

Facility

$37,614.35

Service Code	HCPCS 0234T50
Hospital Charge Code	7411849
Hospital Revenue Code	361
Min. Negotiated Rate	$5,642.15
Max. Negotiated Rate	$5,642.15
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15

DX-RENAL ATHERECTOMY-BI

Facility

$37,914.35

Service Code	HCPCS 0234T50
Hospital Charge Code	2690795
Hospital Revenue Code	361
Min. Negotiated Rate	$5,687.15
Max. Negotiated Rate	$5,687.15
Rate for Payer: Qualcare PPO/HMO/WC	$5,687.15

DX-RENAL ATHERECTOMY-BI

Facility

$37,614.35

Service Code	HCPCS 0234T50
Hospital Charge Code	7411849
Hospital Revenue Code	361
Min. Negotiated Rate	$906.51
Max. Negotiated Rate	$18,807.17
Rate for Payer: Aetna Commercial	$14,293.45
Rate for Payer: Aetna Medicare Advantage	$11,284.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,591.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,591.66
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	$9,591.66
Rate for Payer: Cigna Commercial	$18,807.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,284.31
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15
Rate for Payer: UnitedHealthcare Community & State	$906.51
Rate for Payer: Wellpoint Medicaid Managed Care	$996.78

DX-RENAL ATHERECTOMY-BI

Facility

$37,914.35

Service Code	HCPCS 0234T50
Hospital Charge Code	2690795
Hospital Revenue Code	361
Min. Negotiated Rate	$913.74
Max. Negotiated Rate	$18,957.17
Rate for Payer: Aetna Commercial	$14,407.45
Rate for Payer: Aetna Medicare Advantage	$11,374.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,668.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,668.16
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	$9,668.16
Rate for Payer: Cigna Commercial	$18,957.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,374.31
Rate for Payer: Qualcare PPO/HMO/WC	$5,687.15
Rate for Payer: UnitedHealthcare Community & State	$913.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1,004.73

DX-RENAL ATHERECTOMY-LT

Facility

$37,614.35

Service Code	HCPCS 0234TLT
Hospital Charge Code	7411850
Hospital Revenue Code	361
Min. Negotiated Rate	$5,642.15
Max. Negotiated Rate	$5,642.15
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15

DX-RENAL ATHERECTOMY-LT

Facility

$37,914.35

Service Code	HCPCS 0234TLT
Hospital Charge Code	2690800
Hospital Revenue Code	361
Min. Negotiated Rate	$5,687.15
Max. Negotiated Rate	$5,687.15
Rate for Payer: Qualcare PPO/HMO/WC	$5,687.15

DX-RENAL ATHERECTOMY-LT

Facility

$37,614.35

Service Code	HCPCS 0234TLT
Hospital Charge Code	7411850
Hospital Revenue Code	361
Min. Negotiated Rate	$906.51
Max. Negotiated Rate	$18,807.17
Rate for Payer: Aetna Commercial	$14,293.45
Rate for Payer: Aetna Medicare Advantage	$11,284.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,591.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,591.66
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	$9,591.66
Rate for Payer: Cigna Commercial	$18,807.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,284.31
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15
Rate for Payer: UnitedHealthcare Community & State	$906.51
Rate for Payer: Wellpoint Medicaid Managed Care	$996.78

DX-RENAL ATHERECTOMY-LT

Facility

$37,914.35

Service Code	HCPCS 0234TLT
Hospital Charge Code	2690800
Hospital Revenue Code	361
Min. Negotiated Rate	$913.74
Max. Negotiated Rate	$18,957.17
Rate for Payer: Aetna Commercial	$14,407.45
Rate for Payer: Aetna Medicare Advantage	$11,374.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,668.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,668.16
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	$9,668.16
Rate for Payer: Cigna Commercial	$18,957.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,374.31
Rate for Payer: Qualcare PPO/HMO/WC	$5,687.15
Rate for Payer: UnitedHealthcare Community & State	$913.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1,004.73

DX-RENAL ATHERECTOMY-RT

Facility

$37,914.35

Service Code	HCPCS 0234TRT
Hospital Charge Code	2690805
Hospital Revenue Code	361
Min. Negotiated Rate	$5,687.15
Max. Negotiated Rate	$5,687.15
Rate for Payer: Qualcare PPO/HMO/WC	$5,687.15

DX-RENAL ATHERECTOMY-RT

Facility

$37,614.35

Service Code	HCPCS 0234TRT
Hospital Charge Code	7411851
Hospital Revenue Code	361
Min. Negotiated Rate	$906.51
Max. Negotiated Rate	$18,807.17
Rate for Payer: Aetna Commercial	$14,293.45
Rate for Payer: Aetna Medicare Advantage	$11,284.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,591.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,591.66
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	$9,591.66
Rate for Payer: Cigna Commercial	$18,807.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,284.31
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15
Rate for Payer: UnitedHealthcare Community & State	$906.51
Rate for Payer: Wellpoint Medicaid Managed Care	$996.78

DX-RENAL ATHERECTOMY-RT

Facility

$37,614.35

Service Code	HCPCS 0234TRT
Hospital Charge Code	7411851
Hospital Revenue Code	361
Min. Negotiated Rate	$5,642.15
Max. Negotiated Rate	$5,642.15
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15

DX-RENAL ATHERECTOMY-RT

Facility

$37,914.35

Service Code	HCPCS 0234TRT
Hospital Charge Code	2690805
Hospital Revenue Code	361
Min. Negotiated Rate	$913.74
Max. Negotiated Rate	$18,957.17
Rate for Payer: Aetna Commercial	$14,407.45
Rate for Payer: Aetna Medicare Advantage	$11,374.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,668.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,668.16
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	$9,668.16
Rate for Payer: Cigna Commercial	$18,957.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,374.31
Rate for Payer: Qualcare PPO/HMO/WC	$5,687.15
Rate for Payer: UnitedHealthcare Community & State	$913.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1,004.73

DX-RENAL CYST STUDY RS-BI

Facility

$925.00

Service Code	HCPCS 7447050
Hospital Charge Code	2690715
Hospital Revenue Code	320
Min. Negotiated Rate	$22.29
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$351.50
Rate for Payer: Aetna Medicare Advantage	$277.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$235.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$235.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$235.88
Rate for Payer: Cigna Commercial	$462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$277.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$138.75
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$22.29
Rate for Payer: Wellpoint Medicaid Managed Care	$24.51

DX-RENAL CYST STUDY RS-BI

Facility

$925.00

Service Code	HCPCS 7447050
Hospital Charge Code	2690715
Hospital Revenue Code	320
Min. Negotiated Rate	$138.75
Max. Negotiated Rate	$138.75
Rate for Payer: Qualcare PPO/HMO/WC	$138.75

DX-RENAL CYST STUDY RS-BI

Facility

$925.00

Service Code	HCPCS 7447050
Hospital Charge Code	7411836
Hospital Revenue Code	320
Min. Negotiated Rate	$22.29
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$351.50
Rate for Payer: Aetna Medicare Advantage	$277.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$235.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$235.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$235.88
Rate for Payer: Cigna Commercial	$462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$277.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$138.75
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$22.29
Rate for Payer: Wellpoint Medicaid Managed Care	$24.51

DX-RENAL CYST STUDY RS-BI

Facility

$925.00

Service Code	HCPCS 7447050
Hospital Charge Code	7411836
Hospital Revenue Code	320
Min. Negotiated Rate	$138.75
Max. Negotiated Rate	$138.75
Rate for Payer: Qualcare PPO/HMO/WC	$138.75

DX-RENAL CYST STUDY RS-LT

Facility

$925.00

Service Code	HCPCS 74470LT
Hospital Charge Code	7411994
Hospital Revenue Code	320
Min. Negotiated Rate	$138.75
Max. Negotiated Rate	$138.75
Rate for Payer: Qualcare PPO/HMO/WC	$138.75

DX-RENAL CYST STUDY RS-LT

Facility

$925.00

Service Code	HCPCS 74470LT
Hospital Charge Code	7411994
Hospital Revenue Code	320
Min. Negotiated Rate	$22.29
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$351.50
Rate for Payer: Aetna Medicare Advantage	$277.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$235.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$235.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$235.88
Rate for Payer: Cigna Commercial	$462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$277.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$138.75
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$22.29
Rate for Payer: Wellpoint Medicaid Managed Care	$24.51

DX-RENAL CYST STUDY RS-LT

Facility

$925.00

Service Code	HCPCS 74470LT
Hospital Charge Code	2691770
Hospital Revenue Code	320
Min. Negotiated Rate	$22.29
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$351.50
Rate for Payer: Aetna Medicare Advantage	$277.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$235.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$235.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$235.88
Rate for Payer: Cigna Commercial	$462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$277.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$138.75
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$22.29
Rate for Payer: Wellpoint Medicaid Managed Care	$24.51

Know your out-of-pocket cost for care.

All Charges