Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR CHANGE GASTROSTOMY TUBE

Facility

$776.45

Service Code	HCPCS 43760
Hospital Charge Code	2101175
Hospital Revenue Code	361
Min. Negotiated Rate	$18.71
Max. Negotiated Rate	$862.00
Rate for Payer: Aetna Commercial	$295.05
Rate for Payer: Aetna Medicare Advantage	$232.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.99
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	$197.99
Rate for Payer: Cigna Commercial	$388.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.94
Rate for Payer: Qualcare PPO/HMO/WC	$116.47
Rate for Payer: UnitedHealthcare Community & State	$18.71
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$781.67
Rate for Payer: Wellpoint Medicaid Managed Care	$766.34

IR CHANGE GASTROSTOMY TUBE

Facility

$776.45

Service Code	HCPCS 43760
Hospital Charge Code	7411547
Hospital Revenue Code	361
Min. Negotiated Rate	$18.71
Max. Negotiated Rate	$862.00
Rate for Payer: Aetna Commercial	$295.05
Rate for Payer: Aetna Medicare Advantage	$232.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.99
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	$197.99
Rate for Payer: Cigna Commercial	$388.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.94
Rate for Payer: Qualcare PPO/HMO/WC	$116.47
Rate for Payer: UnitedHealthcare Community & State	$18.71
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$781.67
Rate for Payer: Wellpoint Medicaid Managed Care	$766.34

IR-CHANGE NEPHROST TBE-BI

Facility

$2,840.00

Hospital Charge Code	2690660
Hospital Revenue Code	761
Min. Negotiated Rate	$426.00
Max. Negotiated Rate	$426.00
Rate for Payer: Qualcare PPO/HMO/WC	$426.00

IR-CHANGE NEPHROST TBE-BI

Facility

$2,840.00

Hospital Charge Code	2690660
Hospital Revenue Code	761
Min. Negotiated Rate	$68.44
Max. Negotiated Rate	$1,420.00
Rate for Payer: Aetna Commercial	$1,079.20
Rate for Payer: Aetna Medicare Advantage	$852.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$724.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$724.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$724.20
Rate for Payer: Cigna Commercial	$1,420.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$852.00
Rate for Payer: Oxford Commercial	$568.00
Rate for Payer: Qualcare PPO/HMO/WC	$426.00
Rate for Payer: UnitedHealthcare Commercial	$568.00
Rate for Payer: UnitedHealthcare Community & State	$68.44
Rate for Payer: Wellpoint Medicaid Managed Care	$75.26

IR-CHANGE NEPHROST TBE-LT

Facility

$2,840.00

Hospital Charge Code	2691650
Hospital Revenue Code	761
Min. Negotiated Rate	$426.00
Max. Negotiated Rate	$426.00
Rate for Payer: Qualcare PPO/HMO/WC	$426.00

IR-CHANGE NEPHROST TBE-LT

Facility

$2,840.00

Hospital Charge Code	2691650
Hospital Revenue Code	761
Min. Negotiated Rate	$68.44
Max. Negotiated Rate	$1,420.00
Rate for Payer: Aetna Commercial	$1,079.20
Rate for Payer: Aetna Medicare Advantage	$852.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$724.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$724.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$724.20
Rate for Payer: Cigna Commercial	$1,420.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$852.00
Rate for Payer: Oxford Commercial	$568.00
Rate for Payer: Qualcare PPO/HMO/WC	$426.00
Rate for Payer: UnitedHealthcare Commercial	$568.00
Rate for Payer: UnitedHealthcare Community & State	$68.44
Rate for Payer: Wellpoint Medicaid Managed Care	$75.26

IR-CHANGE NEPHROST TBE-RT

Facility

$2,840.00

Hospital Charge Code	2691655
Hospital Revenue Code	761
Min. Negotiated Rate	$426.00
Max. Negotiated Rate	$426.00
Rate for Payer: Qualcare PPO/HMO/WC	$426.00

IR-CHANGE NEPHROST TBE-RT

Facility

$2,840.00

Hospital Charge Code	2691655
Hospital Revenue Code	761
Min. Negotiated Rate	$68.44
Max. Negotiated Rate	$1,420.00
Rate for Payer: Aetna Commercial	$1,079.20
Rate for Payer: Aetna Medicare Advantage	$852.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$724.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$724.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$724.20
Rate for Payer: Cigna Commercial	$1,420.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$852.00
Rate for Payer: Oxford Commercial	$568.00
Rate for Payer: Qualcare PPO/HMO/WC	$426.00
Rate for Payer: UnitedHealthcare Commercial	$568.00
Rate for Payer: UnitedHealthcare Community & State	$68.44
Rate for Payer: Wellpoint Medicaid Managed Care	$75.26

IR CHANGE PERC BIL DRAIN CATH

Facility

$2,682.45

Hospital Charge Code	2004739
Hospital Revenue Code	361
Min. Negotiated Rate	$64.65
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$1,019.33
Rate for Payer: Aetna Medicare Advantage	$804.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$684.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$684.02
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	$684.02
Rate for Payer: Cigna Commercial	$1,341.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$804.74
Rate for Payer: Qualcare PPO/HMO/WC	$402.37
Rate for Payer: UnitedHealthcare Community & State	$64.65
Rate for Payer: Wellpoint Medicaid Managed Care	$71.08

IR CHANGE PERC BIL DRAIN CATH

Facility

$2,682.45

Hospital Charge Code	2004739
Hospital Revenue Code	361
Min. Negotiated Rate	$402.37
Max. Negotiated Rate	$402.37
Rate for Payer: Qualcare PPO/HMO/WC	$402.37

IR-CHANGE URETER TUBE-BI

Facility

$2,082.00

Service Code	HCPCS 5068850
Hospital Charge Code	7411828
Hospital Revenue Code	361
Min. Negotiated Rate	$312.30
Max. Negotiated Rate	$312.30
Rate for Payer: Qualcare PPO/HMO/WC	$312.30

IR-CHANGE URETER TUBE-BI

Facility

$2,082.00

Service Code	HCPCS 5068850
Hospital Charge Code	7411828
Hospital Revenue Code	361
Min. Negotiated Rate	$50.18
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$791.16
Rate for Payer: Aetna Medicare Advantage	$624.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$530.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$530.91
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	$530.91
Rate for Payer: Cigna Commercial	$1,041.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$624.60
Rate for Payer: Qualcare PPO/HMO/WC	$312.30
Rate for Payer: UnitedHealthcare Community & State	$50.18
Rate for Payer: Wellpoint Medicaid Managed Care	$55.17

IR-CHANGE URETER TUBE-BI

Facility

$2,082.00

Service Code	HCPCS 5068850
Hospital Charge Code	2690675
Hospital Revenue Code	361
Min. Negotiated Rate	$312.30
Max. Negotiated Rate	$312.30
Rate for Payer: Qualcare PPO/HMO/WC	$312.30

IR-CHANGE URETER TUBE-BI

Facility

$2,082.00

Service Code	HCPCS 5068850
Hospital Charge Code	2690675
Hospital Revenue Code	361
Min. Negotiated Rate	$50.18
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$791.16
Rate for Payer: Aetna Medicare Advantage	$624.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$530.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$530.91
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	$530.91
Rate for Payer: Cigna Commercial	$1,041.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$624.60
Rate for Payer: Qualcare PPO/HMO/WC	$312.30
Rate for Payer: UnitedHealthcare Community & State	$50.18
Rate for Payer: Wellpoint Medicaid Managed Care	$55.17

IR-CHANGE URETER TUBE-LT

Facility

$2,082.00

Service Code	HCPCS 50688LT
Hospital Charge Code	2691690
Hospital Revenue Code	361
Min. Negotiated Rate	$50.18
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$791.16
Rate for Payer: Aetna Medicare Advantage	$624.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$530.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$530.91
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	$530.91
Rate for Payer: Cigna Commercial	$1,041.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$624.60
Rate for Payer: Qualcare PPO/HMO/WC	$312.30
Rate for Payer: UnitedHealthcare Community & State	$50.18
Rate for Payer: Wellpoint Medicaid Managed Care	$55.17

IR-CHANGE URETER TUBE-LT

Facility

$2,082.00

Service Code	HCPCS 50688LT
Hospital Charge Code	2691690
Hospital Revenue Code	361
Min. Negotiated Rate	$312.30
Max. Negotiated Rate	$312.30
Rate for Payer: Qualcare PPO/HMO/WC	$312.30

IR-CHANGE URETER TUBE-LT

Facility

$2,082.00

Service Code	HCPCS 50688LT
Hospital Charge Code	7411978
Hospital Revenue Code	361
Min. Negotiated Rate	$312.30
Max. Negotiated Rate	$312.30
Rate for Payer: Qualcare PPO/HMO/WC	$312.30

IR-CHANGE URETER TUBE-LT

Facility

$2,082.00

Service Code	HCPCS 50688LT
Hospital Charge Code	7411978
Hospital Revenue Code	361
Min. Negotiated Rate	$50.18
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$791.16
Rate for Payer: Aetna Medicare Advantage	$624.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$530.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$530.91
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	$530.91
Rate for Payer: Cigna Commercial	$1,041.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$624.60
Rate for Payer: Qualcare PPO/HMO/WC	$312.30
Rate for Payer: UnitedHealthcare Community & State	$50.18
Rate for Payer: Wellpoint Medicaid Managed Care	$55.17

IR-CHANGE URETER TUBE-RT

Facility

$2,082.00

Service Code	HCPCS 50688RT
Hospital Charge Code	2691695
Hospital Revenue Code	361
Min. Negotiated Rate	$50.18
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$791.16
Rate for Payer: Aetna Medicare Advantage	$624.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$530.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$530.91
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	$530.91
Rate for Payer: Cigna Commercial	$1,041.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$624.60
Rate for Payer: Qualcare PPO/HMO/WC	$312.30
Rate for Payer: UnitedHealthcare Community & State	$50.18
Rate for Payer: Wellpoint Medicaid Managed Care	$55.17

IR-CHANGE URETER TUBE-RT

Facility

$2,082.00

Service Code	HCPCS 50688RT
Hospital Charge Code	2691695
Hospital Revenue Code	361
Min. Negotiated Rate	$312.30
Max. Negotiated Rate	$312.30
Rate for Payer: Qualcare PPO/HMO/WC	$312.30

IR-CHANGE URETER TUBE-RT

Facility

$2,082.00

Service Code	HCPCS 50688RT
Hospital Charge Code	7411979
Hospital Revenue Code	361
Min. Negotiated Rate	$312.30
Max. Negotiated Rate	$312.30
Rate for Payer: Qualcare PPO/HMO/WC	$312.30

IR-CHANGE URETER TUBE-RT

Facility

$2,082.00

Service Code	HCPCS 50688RT
Hospital Charge Code	7411979
Hospital Revenue Code	361
Min. Negotiated Rate	$50.18
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$791.16
Rate for Payer: Aetna Medicare Advantage	$624.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$530.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$530.91
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	$530.91
Rate for Payer: Cigna Commercial	$1,041.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$624.60
Rate for Payer: Qualcare PPO/HMO/WC	$312.30
Rate for Payer: UnitedHealthcare Community & State	$50.18
Rate for Payer: Wellpoint Medicaid Managed Care	$55.17

IR-CHOLECYS W/EXPL DRAIN

Facility

$21,000.00

Service Code	HCPCS 47480
Hospital Charge Code	2690135
Hospital Revenue Code	361
Min. Negotiated Rate	$3,150.00
Max. Negotiated Rate	$3,150.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,150.00

IR-CHOLECYS W/EXPL DRAIN

Facility

$21,000.00

Service Code	HCPCS 47480
Hospital Charge Code	2690135
Hospital Revenue Code	361
Min. Negotiated Rate	$506.10
Max. Negotiated Rate	$10,500.00
Rate for Payer: Aetna Commercial	$7,980.00
Rate for Payer: Aetna Medicare Advantage	$6,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,355.00
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	$5,355.00
Rate for Payer: Cigna Commercial	$10,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,300.00
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,150.00
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$506.10
Rate for Payer: Wellpoint Medicaid Managed Care	$556.50

IR-CHOLECYS W/EXPL DRAIN

Facility

$21,000.00

Service Code	HCPCS 47480
Hospital Charge Code	7411557
Hospital Revenue Code	361
Min. Negotiated Rate	$506.10
Max. Negotiated Rate	$10,500.00
Rate for Payer: Aetna Commercial	$7,980.00
Rate for Payer: Aetna Medicare Advantage	$6,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,355.00
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	$5,355.00
Rate for Payer: Cigna Commercial	$10,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,300.00
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,150.00
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$506.10
Rate for Payer: Wellpoint Medicaid Managed Care	$556.50

Know your out-of-pocket cost for care.

All Charges