Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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-RT

Facility

$925.00

Service Code	HCPCS 74470RT
Hospital Charge Code	7411995
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-RT

Facility

$925.00

Service Code	HCPCS 74470RT
Hospital Charge Code	7411995
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-RT

Facility

$925.00

Service Code	HCPCS 74470RT
Hospital Charge Code	2691775
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-RT

Facility

$925.00

Service Code	HCPCS 74470RT
Hospital Charge Code	2691775
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 VENOGRAPHY-BI

Facility

$8,633.00

Service Code	HCPCS 7583350
Hospital Charge Code	2690760
Hospital Revenue Code	320
Min. Negotiated Rate	$208.06
Max. Negotiated Rate	$4,316.50
Rate for Payer: Aetna Commercial	$3,280.54
Rate for Payer: Aetna Medicare Advantage	$2,589.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,201.41
Rate for Payer: Cigna Commercial	$4,316.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,589.90
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$208.06
Rate for Payer: Wellpoint Medicaid Managed Care	$228.77

DX-RENAL VENOGRAPHY-BI

Facility

$8,633.00

Service Code	HCPCS 7583350
Hospital Charge Code	2690760
Hospital Revenue Code	320
Min. Negotiated Rate	$1,294.95
Max. Negotiated Rate	$1,294.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95

DX-RENAL VENOGRAPHY-BI

Facility

$8,633.00

Service Code	HCPCS 7583350
Hospital Charge Code	7411841
Hospital Revenue Code	320
Min. Negotiated Rate	$1,294.95
Max. Negotiated Rate	$1,294.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95

DX-RENAL VENOGRAPHY-BI

Facility

$8,633.00

Service Code	HCPCS 7583350
Hospital Charge Code	7411841
Hospital Revenue Code	320
Min. Negotiated Rate	$208.06
Max. Negotiated Rate	$4,316.50
Rate for Payer: Aetna Commercial	$3,280.54
Rate for Payer: Aetna Medicare Advantage	$2,589.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,201.41
Rate for Payer: Cigna Commercial	$4,316.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,589.90
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$208.06
Rate for Payer: Wellpoint Medicaid Managed Care	$228.77

DX-RENAL VENOGRAPHY-LT

Facility

$14,614.45

Service Code	HCPCS 75831LT
Hospital Charge Code	366875831L
Hospital Revenue Code	320
Min. Negotiated Rate	$352.21
Max. Negotiated Rate	$7,307.23
Rate for Payer: Aetna Commercial	$5,553.49
Rate for Payer: Aetna Medicare Advantage	$4,384.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,726.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,726.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,726.68
Rate for Payer: Cigna Commercial	$7,307.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,384.34
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,192.17
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$352.21
Rate for Payer: Wellpoint Medicaid Managed Care	$387.28

DX-RENAL VENOGRAPHY-LT

Facility

$14,614.45

Service Code	HCPCS 75831LT
Hospital Charge Code	2691940
Hospital Revenue Code	320
Min. Negotiated Rate	$352.21
Max. Negotiated Rate	$7,307.23
Rate for Payer: Aetna Commercial	$5,553.49
Rate for Payer: Aetna Medicare Advantage	$4,384.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,726.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,726.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,726.68
Rate for Payer: Cigna Commercial	$7,307.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,384.34
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,192.17
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$352.21
Rate for Payer: Wellpoint Medicaid Managed Care	$387.28

DX-RENAL VENOGRAPHY-LT

Facility

$8,633.00

Service Code	HCPCS 75831LT
Hospital Charge Code	7412014
Hospital Revenue Code	320
Min. Negotiated Rate	$1,294.95
Max. Negotiated Rate	$1,294.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95

DX-RENAL VENOGRAPHY-LT

Facility

$14,614.45

Service Code	HCPCS 75831LT
Hospital Charge Code	2691940
Hospital Revenue Code	320
Min. Negotiated Rate	$2,192.17
Max. Negotiated Rate	$2,192.17
Rate for Payer: Qualcare PPO/HMO/WC	$2,192.17

DX-RENAL VENOGRAPHY-LT

Facility

$14,614.45

Service Code	HCPCS 75831LT
Hospital Charge Code	366875831L
Hospital Revenue Code	320
Min. Negotiated Rate	$2,192.17
Max. Negotiated Rate	$2,192.17
Rate for Payer: Qualcare PPO/HMO/WC	$2,192.17

DX-RENAL VENOGRAPHY-LT

Facility

$8,633.00

Service Code	HCPCS 75831LT
Hospital Charge Code	7412014
Hospital Revenue Code	320
Min. Negotiated Rate	$208.06
Max. Negotiated Rate	$4,316.50
Rate for Payer: Aetna Commercial	$3,280.54
Rate for Payer: Aetna Medicare Advantage	$2,589.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,201.41
Rate for Payer: Cigna Commercial	$4,316.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,589.90
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$208.06
Rate for Payer: Wellpoint Medicaid Managed Care	$228.77

DX-RENAL VENOGRAPHY-RT

Facility

$14,614.45

Service Code	HCPCS 75831RT
Hospital Charge Code	366875831R
Hospital Revenue Code	320
Min. Negotiated Rate	$2,192.17
Max. Negotiated Rate	$2,192.17
Rate for Payer: Qualcare PPO/HMO/WC	$2,192.17

DX-RENAL VENOGRAPHY-RT

Facility

$14,614.45

Service Code	HCPCS 75831RT
Hospital Charge Code	2691945
Hospital Revenue Code	320
Min. Negotiated Rate	$352.21
Max. Negotiated Rate	$7,307.23
Rate for Payer: Aetna Commercial	$5,553.49
Rate for Payer: Aetna Medicare Advantage	$4,384.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,726.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,726.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,726.68
Rate for Payer: Cigna Commercial	$7,307.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,384.34
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,192.17
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$352.21
Rate for Payer: Wellpoint Medicaid Managed Care	$387.28

DX-RENAL VENOGRAPHY-RT

Facility

$8,633.00

Service Code	HCPCS 75831RT
Hospital Charge Code	7412015
Hospital Revenue Code	320
Min. Negotiated Rate	$1,294.95
Max. Negotiated Rate	$1,294.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95

DX-RENAL VENOGRAPHY-RT

Facility

$14,614.45

Service Code	HCPCS 75831RT
Hospital Charge Code	366875831R
Hospital Revenue Code	320
Min. Negotiated Rate	$352.21
Max. Negotiated Rate	$7,307.23
Rate for Payer: Aetna Commercial	$5,553.49
Rate for Payer: Aetna Medicare Advantage	$4,384.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,726.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,726.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,726.68
Rate for Payer: Cigna Commercial	$7,307.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,384.34
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,192.17
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$352.21
Rate for Payer: Wellpoint Medicaid Managed Care	$387.28

DX-RENAL VENOGRAPHY-RT

Facility

$14,614.45

Service Code	HCPCS 75831RT
Hospital Charge Code	2691945
Hospital Revenue Code	320
Min. Negotiated Rate	$2,192.17
Max. Negotiated Rate	$2,192.17
Rate for Payer: Qualcare PPO/HMO/WC	$2,192.17

DX-RENAL VENOGRAPHY-RT

Facility

$8,633.00

Service Code	HCPCS 75831RT
Hospital Charge Code	7412015
Hospital Revenue Code	320
Min. Negotiated Rate	$208.06
Max. Negotiated Rate	$4,316.50
Rate for Payer: Aetna Commercial	$3,280.54
Rate for Payer: Aetna Medicare Advantage	$2,589.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,201.41
Rate for Payer: Cigna Commercial	$4,316.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,589.90
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$208.06
Rate for Payer: Wellpoint Medicaid Managed Care	$228.77

DX-REPL IV CATH (LYSIS)

Facility

$5,100.00

Hospital Charge Code	2690255
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-REPL IV CATH (LYSIS)

Facility

$5,100.00

Hospital Charge Code	2690255
Hospital Revenue Code	320
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

DX-REPL PERC DRAIN

Facility

$2,625.00

Service Code	HCPCS 7598450
Hospital Charge Code	7411844
Hospital Revenue Code	320
Min. Negotiated Rate	$63.26
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$997.50
Rate for Payer: Aetna Medicare Advantage	$787.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.38
Rate for Payer: Cigna Commercial	$1,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$393.75
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$63.26
Rate for Payer: Wellpoint Medicaid Managed Care	$69.56

DX-REPL PERC DRAIN

Facility

$2,625.00

Service Code	HCPCS 7598450
Hospital Charge Code	7411844
Hospital Revenue Code	320
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$393.75
Rate for Payer: Qualcare PPO/HMO/WC	$393.75

Know your out-of-pocket cost for care.

All Charges