Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR DILATE BILIARY DUCT/AMPULLA

Facility

$732.00

Service Code	HCPCS 47542
Hospital Charge Code	7411570
Hospital Revenue Code	361
Min. Negotiated Rate	$109.80
Max. Negotiated Rate	$109.80
Rate for Payer: Qualcare PPO/HMO/WC	$109.80

IR DILATE BILIARY DUCT/AMPULLA

Facility

$732.00

Service Code	HCPCS 47542
Hospital Charge Code	321047542
Hospital Revenue Code	361
Min. Negotiated Rate	$17.64
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$278.16
Rate for Payer: Aetna Medicare Advantage	$219.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$186.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$186.66
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	$186.66
Rate for Payer: Cigna Commercial	$366.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.60
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$109.80
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$17.64
Rate for Payer: Wellpoint Medicaid Managed Care	$19.40

IR DILATE BILIARY DUCT/AMPULLA

Facility

$732.00

Service Code	HCPCS 47542
Hospital Charge Code	321047542
Hospital Revenue Code	361
Min. Negotiated Rate	$109.80
Max. Negotiated Rate	$109.80
Rate for Payer: Qualcare PPO/HMO/WC	$109.80

IR DILATE BILIARY DUCT/AMPULLA

Facility

$732.00

Service Code	HCPCS 47542
Hospital Charge Code	2692121
Hospital Revenue Code	361
Min. Negotiated Rate	$109.80
Max. Negotiated Rate	$109.80
Rate for Payer: Qualcare PPO/HMO/WC	$109.80

IR DIL BILIARY DUCT W/ STENT

Facility

$24,264.20

Service Code	HCPCS 47556
Hospital Charge Code	411047556
Hospital Revenue Code	361
Min. Negotiated Rate	$584.77
Max. Negotiated Rate	$45,585.17
Rate for Payer: Aetna Commercial	$34,349.57
Rate for Payer: Aetna Medicare Advantage	$40,916.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45,585.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45,585.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,628.52
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	$45,585.17
Rate for Payer: Cigna Commercial	$25,313.84
Rate for Payer: Cigna Medicare Advantage	$12,628.52
Rate for Payer: Clover Medicare Advantage	$11,997.09
Rate for Payer: EmblemHealth Commercial	$37,885.56
Rate for Payer: Humana Medicare Advantage	$13,007.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,628.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,279.26
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,639.63
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$584.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,628.52
Rate for Payer: Wellcare Medicare Advantage	$12,628.52
Rate for Payer: Wellpoint Medicaid Managed Care	$643.00

IR DIL BILIARY DUCT W/ STENT

Facility

$26,912.85

Service Code	HCPCS 47556
Hospital Charge Code	2000940
Hospital Revenue Code	361
Min. Negotiated Rate	$648.60
Max. Negotiated Rate	$45,585.17
Rate for Payer: Aetna Commercial	$34,349.57
Rate for Payer: Aetna Medicare Advantage	$40,916.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45,585.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45,585.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,628.52
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	$45,585.17
Rate for Payer: Cigna Commercial	$25,313.84
Rate for Payer: Cigna Medicare Advantage	$12,628.52
Rate for Payer: Clover Medicare Advantage	$11,997.09
Rate for Payer: EmblemHealth Commercial	$37,885.56
Rate for Payer: Humana Medicare Advantage	$13,007.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,628.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,073.85
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,036.93
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$648.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,628.52
Rate for Payer: Wellcare Medicare Advantage	$12,628.52
Rate for Payer: Wellpoint Medicaid Managed Care	$713.19

IR DIL BILIARY DUCT W/ STENT

Facility

$26,912.85

Service Code	HCPCS 47556
Hospital Charge Code	2000940
Hospital Revenue Code	361
Min. Negotiated Rate	$4,036.93
Max. Negotiated Rate	$4,036.93
Rate for Payer: Qualcare PPO/HMO/WC	$4,036.93

IR DIL BILIARY DUCT W/ STENT

Facility

$26,912.85

Service Code	HCPCS 47556
Hospital Charge Code	321047556
Hospital Revenue Code	361
Min. Negotiated Rate	$648.60
Max. Negotiated Rate	$45,585.17
Rate for Payer: Aetna Commercial	$34,349.57
Rate for Payer: Aetna Medicare Advantage	$40,916.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45,585.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45,585.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,628.52
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	$45,585.17
Rate for Payer: Cigna Commercial	$25,313.84
Rate for Payer: Cigna Medicare Advantage	$12,628.52
Rate for Payer: Clover Medicare Advantage	$11,997.09
Rate for Payer: EmblemHealth Commercial	$37,885.56
Rate for Payer: Humana Medicare Advantage	$13,007.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,628.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,073.85
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,036.93
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$648.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,628.52
Rate for Payer: Wellcare Medicare Advantage	$12,628.52
Rate for Payer: Wellpoint Medicaid Managed Care	$713.19

IR DIL BILIARY DUCT W/ STENT

Facility

$24,264.20

Service Code	HCPCS 47556
Hospital Charge Code	411047556
Hospital Revenue Code	361
Min. Negotiated Rate	$3,639.63
Max. Negotiated Rate	$3,639.63
Rate for Payer: Qualcare PPO/HMO/WC	$3,639.63

IR DIL BILIARY DUCT W/ STENT

Facility

$13,811.90

Service Code	HCPCS 47556
Hospital Charge Code	7411573
Hospital Revenue Code	361
Min. Negotiated Rate	$332.87
Max. Negotiated Rate	$45,585.17
Rate for Payer: Aetna Commercial	$34,349.57
Rate for Payer: Aetna Medicare Advantage	$40,916.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45,585.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45,585.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,628.52
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	$45,585.17
Rate for Payer: Cigna Commercial	$25,313.84
Rate for Payer: Cigna Medicare Advantage	$12,628.52
Rate for Payer: Clover Medicare Advantage	$11,997.09
Rate for Payer: EmblemHealth Commercial	$37,885.56
Rate for Payer: Humana Medicare Advantage	$13,007.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,628.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,143.57
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,071.78
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$332.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,628.52
Rate for Payer: Wellcare Medicare Advantage	$12,628.52
Rate for Payer: Wellpoint Medicaid Managed Care	$366.02

IR DIL BILIARY DUCT W/ STENT

Facility

$26,912.85

Service Code	HCPCS 47556
Hospital Charge Code	321047556
Hospital Revenue Code	361
Min. Negotiated Rate	$4,036.93
Max. Negotiated Rate	$4,036.93
Rate for Payer: Qualcare PPO/HMO/WC	$4,036.93

IR DIL BILIARY DUCT W/ STENT

Facility

$13,811.90

Service Code	HCPCS 47556
Hospital Charge Code	7411573
Hospital Revenue Code	361
Min. Negotiated Rate	$2,071.78
Max. Negotiated Rate	$2,071.78
Rate for Payer: Qualcare PPO/HMO/WC	$2,071.78

IR DIL BILIARY DUCT W/ STENT

Facility

$24,264.20

Service Code	HCPCS 47556
Hospital Charge Code	366847556
Hospital Revenue Code	361
Min. Negotiated Rate	$3,639.63
Max. Negotiated Rate	$3,639.63
Rate for Payer: Qualcare PPO/HMO/WC	$3,639.63

IR DIL BILIARY DUCT W/ STENT

Facility

$24,264.20

Service Code	HCPCS 47556
Hospital Charge Code	366847556
Hospital Revenue Code	361
Min. Negotiated Rate	$584.77
Max. Negotiated Rate	$45,585.17
Rate for Payer: Aetna Commercial	$34,349.57
Rate for Payer: Aetna Medicare Advantage	$40,916.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45,585.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45,585.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,628.52
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	$45,585.17
Rate for Payer: Cigna Commercial	$25,313.84
Rate for Payer: Cigna Medicare Advantage	$12,628.52
Rate for Payer: Clover Medicare Advantage	$11,997.09
Rate for Payer: EmblemHealth Commercial	$37,885.56
Rate for Payer: Humana Medicare Advantage	$13,007.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,628.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,279.26
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,639.63
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$584.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,628.52
Rate for Payer: Wellcare Medicare Advantage	$12,628.52
Rate for Payer: Wellpoint Medicaid Managed Care	$643.00

IR-DIL OF URETER-BIL

Facility

$327.00

Service Code	HCPCS 5389950
Hospital Charge Code	7411830
Hospital Revenue Code	361
Min. Negotiated Rate	$49.05
Max. Negotiated Rate	$49.05
Rate for Payer: Qualcare PPO/HMO/WC	$49.05

IR-DIL OF URETER-BIL

Facility

$327.00

Service Code	HCPCS 5389950
Hospital Charge Code	7411830
Hospital Revenue Code	361
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$124.26
Rate for Payer: Aetna Medicare Advantage	$98.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.39
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	$83.39
Rate for Payer: Cigna Commercial	$163.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.10
Rate for Payer: Qualcare PPO/HMO/WC	$49.05
Rate for Payer: UnitedHealthcare Community & State	$7.88
Rate for Payer: Wellpoint Medicaid Managed Care	$8.67

IR-DIL OF URETER-BIL

Facility

$327.00

Service Code	HCPCS 5389950
Hospital Charge Code	2690685
Hospital Revenue Code	361
Min. Negotiated Rate	$49.05
Max. Negotiated Rate	$49.05
Rate for Payer: Qualcare PPO/HMO/WC	$49.05

IR-DIL OF URETER-BIL

Facility

$327.00

Service Code	HCPCS 5389950
Hospital Charge Code	2690685
Hospital Revenue Code	361
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$124.26
Rate for Payer: Aetna Medicare Advantage	$98.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.39
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	$83.39
Rate for Payer: Cigna Commercial	$163.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.10
Rate for Payer: Qualcare PPO/HMO/WC	$49.05
Rate for Payer: UnitedHealthcare Community & State	$7.88
Rate for Payer: Wellpoint Medicaid Managed Care	$8.67

IR-DIL OF URETER-LT

Facility

$327.00

Service Code	HCPCS 53899LT
Hospital Charge Code	7411982
Hospital Revenue Code	361
Min. Negotiated Rate	$49.05
Max. Negotiated Rate	$49.05
Rate for Payer: Qualcare PPO/HMO/WC	$49.05

IR-DIL OF URETER-LT

Facility

$327.00

Service Code	HCPCS 53899LT
Hospital Charge Code	7411982
Hospital Revenue Code	361
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$124.26
Rate for Payer: Aetna Medicare Advantage	$98.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.39
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	$83.39
Rate for Payer: Cigna Commercial	$163.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.10
Rate for Payer: Qualcare PPO/HMO/WC	$49.05
Rate for Payer: UnitedHealthcare Community & State	$7.88
Rate for Payer: Wellpoint Medicaid Managed Care	$8.67

IR-DIL OF URETER-LT

Facility

$327.00

Service Code	HCPCS 53899LT
Hospital Charge Code	2691710
Hospital Revenue Code	361
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$124.26
Rate for Payer: Aetna Medicare Advantage	$98.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.39
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	$83.39
Rate for Payer: Cigna Commercial	$163.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.10
Rate for Payer: Qualcare PPO/HMO/WC	$49.05
Rate for Payer: UnitedHealthcare Community & State	$7.88
Rate for Payer: Wellpoint Medicaid Managed Care	$8.67

IR-DIL OF URETER-LT

Facility

$327.00

Service Code	HCPCS 53899LT
Hospital Charge Code	2691710
Hospital Revenue Code	361
Min. Negotiated Rate	$49.05
Max. Negotiated Rate	$49.05
Rate for Payer: Qualcare PPO/HMO/WC	$49.05

IR-DIL OF URETER-RT

Facility

$1,355.15

Service Code	HCPCS 53899RT
Hospital Charge Code	2691715
Hospital Revenue Code	361
Min. Negotiated Rate	$203.27
Max. Negotiated Rate	$203.27
Rate for Payer: Qualcare PPO/HMO/WC	$203.27

IR-DIL OF URETER-RT

Facility

$1,355.15

Service Code	HCPCS 53899RT
Hospital Charge Code	411053899
Hospital Revenue Code	361
Min. Negotiated Rate	$203.27
Max. Negotiated Rate	$203.27
Rate for Payer: Qualcare PPO/HMO/WC	$203.27

IR-DIL OF URETER-RT

Facility

$1,355.15

Service Code	HCPCS 53899RT
Hospital Charge Code	366853899R
Hospital Revenue Code	361
Min. Negotiated Rate	$32.66
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$514.96
Rate for Payer: Aetna Medicare Advantage	$406.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.56
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	$345.56
Rate for Payer: Cigna Commercial	$677.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$406.55
Rate for Payer: Qualcare PPO/HMO/WC	$203.27
Rate for Payer: UnitedHealthcare Community & State	$32.66
Rate for Payer: Wellpoint Medicaid Managed Care	$35.91

Know your out-of-pocket cost for care.

All Charges