Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

EXCHANGE NEPHROSTOMY CATH LT

Facility

$3,090.18

Service Code	HCPCS 50435LT
Hospital Charge Code	2101162
Hospital Revenue Code	361
Min. Negotiated Rate	$74.47
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$1,174.27
Rate for Payer: Aetna Medicare Advantage	$927.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$788.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$788.00
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	$788.00
Rate for Payer: Cigna Commercial	$1,545.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$927.05
Rate for Payer: Qualcare PPO/HMO/WC	$463.53
Rate for Payer: UnitedHealthcare Community & State	$74.47
Rate for Payer: Wellpoint Medicaid Managed Care	$81.89

EXCHANGE NEPHROSTOMY CATH LT

Facility

$3,090.18

Service Code	HCPCS 50435LT
Hospital Charge Code	2011590
Hospital Revenue Code	361
Min. Negotiated Rate	$463.53
Max. Negotiated Rate	$463.53
Rate for Payer: Qualcare PPO/HMO/WC	$463.53

EXCHANGE NEPHROSTOMY CATH LT

Facility

$3,090.18

Service Code	HCPCS 50435LT
Hospital Charge Code	2011590
Hospital Revenue Code	361
Min. Negotiated Rate	$74.47
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$1,174.27
Rate for Payer: Aetna Medicare Advantage	$927.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$788.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$788.00
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	$788.00
Rate for Payer: Cigna Commercial	$1,545.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$927.05
Rate for Payer: Qualcare PPO/HMO/WC	$463.53
Rate for Payer: UnitedHealthcare Community & State	$74.47
Rate for Payer: Wellpoint Medicaid Managed Care	$81.89

EXCHANGE NEPHROSTOMY CATH LT

Facility

$3,090.18

Service Code	HCPCS 50435LT
Hospital Charge Code	7412037
Hospital Revenue Code	361
Min. Negotiated Rate	$74.47
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$1,174.27
Rate for Payer: Aetna Medicare Advantage	$927.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$788.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$788.00
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	$788.00
Rate for Payer: Cigna Commercial	$1,545.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$927.05
Rate for Payer: Qualcare PPO/HMO/WC	$463.53
Rate for Payer: UnitedHealthcare Community & State	$74.47
Rate for Payer: Wellpoint Medicaid Managed Care	$81.89

EXCHANGE NEPHROSTOMY CATH LT

Facility

$3,090.18

Service Code	HCPCS 50435LT
Hospital Charge Code	7412037
Hospital Revenue Code	361
Min. Negotiated Rate	$463.53
Max. Negotiated Rate	$463.53
Rate for Payer: Qualcare PPO/HMO/WC	$463.53

EXCHANGE NEPHROSTOMY CATH RT

Facility

$3,090.18

Service Code	HCPCS 50435RT
Hospital Charge Code	2011583
Hospital Revenue Code	361
Min. Negotiated Rate	$463.53
Max. Negotiated Rate	$463.53
Rate for Payer: Qualcare PPO/HMO/WC	$463.53

EXCHANGE NEPHROSTOMY CATH RT

Facility

$3,090.18

Service Code	HCPCS 50435RT
Hospital Charge Code	2011583
Hospital Revenue Code	361
Min. Negotiated Rate	$74.47
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$1,174.27
Rate for Payer: Aetna Medicare Advantage	$927.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$788.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$788.00
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	$788.00
Rate for Payer: Cigna Commercial	$1,545.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$927.05
Rate for Payer: Qualcare PPO/HMO/WC	$463.53
Rate for Payer: UnitedHealthcare Community & State	$74.47
Rate for Payer: Wellpoint Medicaid Managed Care	$81.89

EXCHANGE NEPHROSTOMY CATH RT

Facility

$3,090.18

Service Code	HCPCS 50435RT
Hospital Charge Code	2101159
Hospital Revenue Code	361
Min. Negotiated Rate	$74.47
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$1,174.27
Rate for Payer: Aetna Medicare Advantage	$927.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$788.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$788.00
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	$788.00
Rate for Payer: Cigna Commercial	$1,545.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$927.05
Rate for Payer: Qualcare PPO/HMO/WC	$463.53
Rate for Payer: UnitedHealthcare Community & State	$74.47
Rate for Payer: Wellpoint Medicaid Managed Care	$81.89

EXCHANGE NEPHROSTOMY CATH RT

Facility

$3,090.18

Service Code	HCPCS 50435RT
Hospital Charge Code	7412036
Hospital Revenue Code	361
Min. Negotiated Rate	$74.47
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$1,174.27
Rate for Payer: Aetna Medicare Advantage	$927.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$788.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$788.00
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	$788.00
Rate for Payer: Cigna Commercial	$1,545.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$927.05
Rate for Payer: Qualcare PPO/HMO/WC	$463.53
Rate for Payer: UnitedHealthcare Community & State	$74.47
Rate for Payer: Wellpoint Medicaid Managed Care	$81.89

EXCHANGE NEPHROSTOMY CATH RT

Facility

$3,090.18

Service Code	HCPCS 50435RT
Hospital Charge Code	2101159
Hospital Revenue Code	361
Min. Negotiated Rate	$463.53
Max. Negotiated Rate	$463.53
Rate for Payer: Qualcare PPO/HMO/WC	$463.53

EXCHANGE NEPHROSTOMY CATH RT

Facility

$3,090.18

Service Code	HCPCS 50435RT
Hospital Charge Code	7412036
Hospital Revenue Code	361
Min. Negotiated Rate	$463.53
Max. Negotiated Rate	$463.53
Rate for Payer: Qualcare PPO/HMO/WC	$463.53

EXCHANGE PIN

Facility

$625.00

Service Code	HCPCS C1713
Hospital Charge Code	270698725
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$137.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

EXCHANGE PIN

Facility

$625.00

Service Code	HCPCS C1713
Hospital Charge Code	270698725
Hospital Revenue Code	278
Min. Negotiated Rate	$15.06
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$137.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Community & State	$15.06
Rate for Payer: Wellpoint Medicaid Managed Care	$16.56

EXCHANGE PIN 3.2MM

Facility

$535.00

Hospital Charge Code	270692841
Hospital Revenue Code	272
Min. Negotiated Rate	$12.89
Max. Negotiated Rate	$267.50
Rate for Payer: Aetna Commercial	$203.30
Rate for Payer: Aetna Medicare Advantage	$160.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.43
Rate for Payer: Cigna Commercial	$267.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.50
Rate for Payer: Oxford Commercial	$107.00
Rate for Payer: Qualcare PPO/HMO/WC	$80.25
Rate for Payer: UnitedHealthcare Commercial	$107.00
Rate for Payer: UnitedHealthcare Community & State	$12.89
Rate for Payer: Wellpoint Medicaid Managed Care	$14.18

EXCHANGE PIN 3.2MM

Facility

$535.00

Hospital Charge Code	270692841
Hospital Revenue Code	272
Min. Negotiated Rate	$80.25
Max. Negotiated Rate	$80.25
Rate for Payer: Qualcare PPO/HMO/WC	$80.25

EXCHANGER TRACHEAL TUBE****

Facility

$10.00

Hospital Charge Code	8003568
Hospital Revenue Code	272
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$5.00
Rate for Payer: Aetna Commercial	$3.80
Rate for Payer: Aetna Medicare Advantage	$3.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.55
Rate for Payer: Cigna Commercial	$5.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.00
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.50
Rate for Payer: UnitedHealthcare Commercial	$2.00
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

EXCHANGER TRACHEAL TUBE****

Facility

$10.00

Hospital Charge Code	8003568
Hospital Revenue Code	272
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.50

EXCHANGE TRANSFUSION TRAY

Facility

$63.25

Hospital Charge Code	1801083
Hospital Revenue Code	272
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$31.62
Rate for Payer: Aetna Commercial	$24.04
Rate for Payer: Aetna Medicare Advantage	$18.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.13
Rate for Payer: Cigna Commercial	$31.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.98
Rate for Payer: Oxford Commercial	$12.65
Rate for Payer: Qualcare PPO/HMO/WC	$9.49
Rate for Payer: UnitedHealthcare Commercial	$12.65
Rate for Payer: UnitedHealthcare Community & State	$1.52
Rate for Payer: Wellpoint Medicaid Managed Care	$1.68

EXCHANGE TRANSFUSION TRAY

Facility

$63.25

Hospital Charge Code	1801083
Hospital Revenue Code	272
Min. Negotiated Rate	$9.49
Max. Negotiated Rate	$9.49
Rate for Payer: Qualcare PPO/HMO/WC	$9.49

EXCHANGE TUBE DR BILIARY

Facility

$2,145.95

Service Code	HCPCS 47525
Hospital Charge Code	5100508
Hospital Revenue Code	361
Min. Negotiated Rate	$51.72
Max. Negotiated Rate	$1,072.97
Rate for Payer: Aetna Commercial	$815.46
Rate for Payer: Aetna Medicare Advantage	$643.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$547.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$547.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$547.22
Rate for Payer: Cigna Commercial	$1,072.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$643.78
Rate for Payer: Qualcare PPO/HMO/WC	$321.89
Rate for Payer: UnitedHealthcare Community & State	$51.72
Rate for Payer: Wellpoint Medicaid Managed Care	$56.87

EXCHANGE TUBE DR BILIARY

Facility

$2,145.95

Service Code	HCPCS 47525
Hospital Charge Code	5100508
Hospital Revenue Code	361
Min. Negotiated Rate	$321.89
Max. Negotiated Rate	$321.89
Rate for Payer: Qualcare PPO/HMO/WC	$321.89

EXCHANGE WIRE 260J

Facility

$52.50

Hospital Charge Code	2709002251
Hospital Revenue Code	272
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$7.88
Rate for Payer: Qualcare PPO/HMO/WC	$7.88

EXCHANGE WIRE 260J

Facility

$10.50

Service Code	HCPCS C1769
Hospital Charge Code	270654358N
Hospital Revenue Code	278
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna Commercial	$3.99
Rate for Payer: Aetna Medicare Advantage	$3.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.68
Rate for Payer: Cigna Commercial	$5.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$1.57
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

EXCHANGE WIRE 260J

Facility

$52.50

Hospital Charge Code	2709002251
Hospital Revenue Code	272
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Commercial	$19.95
Rate for Payer: Aetna Medicare Advantage	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.39
Rate for Payer: Cigna Commercial	$26.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.75
Rate for Payer: Oxford Commercial	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.88
Rate for Payer: UnitedHealthcare Commercial	$10.50
Rate for Payer: UnitedHealthcare Community & State	$1.27
Rate for Payer: Wellpoint Medicaid Managed Care	$1.39

EXCHANGE WIRE 260J

Facility

$48.95

Service Code	HCPCS C1769
Hospital Charge Code	270654358S
Hospital Revenue Code	278
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$24.48
Rate for Payer: Aetna Commercial	$18.60
Rate for Payer: Aetna Medicare Advantage	$14.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.48
Rate for Payer: Cigna Commercial	$24.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$10.77
Rate for Payer: Qualcare PPO/HMO/WC	$7.34
Rate for Payer: UnitedHealthcare Community & State	$1.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.30

Know your out-of-pocket cost for care.

All Charges