Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR-PERC DRAIN LESION-RT

Facility

$985.00

Service Code	HCPCS 32201RT
Hospital Charge Code	2691005
Hospital Revenue Code	761
Min. Negotiated Rate	$23.74
Max. Negotiated Rate	$492.50
Rate for Payer: Aetna Commercial	$374.30
Rate for Payer: Aetna Medicare Advantage	$295.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$251.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$251.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$251.18
Rate for Payer: Cigna Commercial	$492.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$295.50
Rate for Payer: Oxford Commercial	$197.00
Rate for Payer: Qualcare PPO/HMO/WC	$147.75
Rate for Payer: UnitedHealthcare Commercial	$197.00
Rate for Payer: UnitedHealthcare Community & State	$23.74
Rate for Payer: Wellpoint Medicaid Managed Care	$26.10

IR-PERC FNA PLEURA-BIL

Facility

$3,604.80

Service Code	HCPCS 1002250
Hospital Charge Code	2690295
Hospital Revenue Code	361
Min. Negotiated Rate	$86.88
Max. Negotiated Rate	$1,802.40
Rate for Payer: Aetna Commercial	$1,369.82
Rate for Payer: Aetna Medicare Advantage	$1,081.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$919.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$919.22
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	$919.22
Rate for Payer: Cigna Commercial	$1,802.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,081.44
Rate for Payer: Qualcare PPO/HMO/WC	$540.72
Rate for Payer: UnitedHealthcare Community & State	$86.88
Rate for Payer: Wellpoint Medicaid Managed Care	$95.53

IR-PERC FNA PLEURA-BIL

Facility

$3,604.80

Service Code	HCPCS 1002250
Hospital Charge Code	2690295
Hospital Revenue Code	361
Min. Negotiated Rate	$540.72
Max. Negotiated Rate	$540.72
Rate for Payer: Qualcare PPO/HMO/WC	$540.72

IR-PERC FNA PLEURA-BIL

Facility

$1,364.00

Service Code	HCPCS 1002250
Hospital Charge Code	7411769
Hospital Revenue Code	361
Min. Negotiated Rate	$32.87
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$518.32
Rate for Payer: Aetna Medicare Advantage	$409.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$347.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$347.82
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	$347.82
Rate for Payer: Cigna Commercial	$682.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$409.20
Rate for Payer: Qualcare PPO/HMO/WC	$204.60
Rate for Payer: UnitedHealthcare Community & State	$32.87
Rate for Payer: Wellpoint Medicaid Managed Care	$36.15

IR-PERC FNA PLEURA-BIL

Facility

$1,364.00

Service Code	HCPCS 1002250
Hospital Charge Code	7411769
Hospital Revenue Code	361
Min. Negotiated Rate	$204.60
Max. Negotiated Rate	$204.60
Rate for Payer: Qualcare PPO/HMO/WC	$204.60

IR-PERC FNA PLEURA-LT

Facility

$1,364.00

Service Code	HCPCS 10022LT
Hospital Charge Code	7411857
Hospital Revenue Code	361
Min. Negotiated Rate	$204.60
Max. Negotiated Rate	$204.60
Rate for Payer: Qualcare PPO/HMO/WC	$204.60

IR-PERC FNA PLEURA-LT

Facility

$2,403.20

Service Code	HCPCS 10022LT
Hospital Charge Code	2690860
Hospital Revenue Code	361
Min. Negotiated Rate	$57.92
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$913.22
Rate for Payer: Aetna Medicare Advantage	$720.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.82
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	$612.82
Rate for Payer: Cigna Commercial	$1,201.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$720.96
Rate for Payer: Qualcare PPO/HMO/WC	$360.48
Rate for Payer: UnitedHealthcare Community & State	$57.92
Rate for Payer: Wellpoint Medicaid Managed Care	$63.68

IR-PERC FNA PLEURA-LT

Facility

$1,364.00

Service Code	HCPCS 10022LT
Hospital Charge Code	7411857
Hospital Revenue Code	361
Min. Negotiated Rate	$32.87
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$518.32
Rate for Payer: Aetna Medicare Advantage	$409.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$347.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$347.82
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	$347.82
Rate for Payer: Cigna Commercial	$682.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$409.20
Rate for Payer: Qualcare PPO/HMO/WC	$204.60
Rate for Payer: UnitedHealthcare Community & State	$32.87
Rate for Payer: Wellpoint Medicaid Managed Care	$36.15

IR-PERC FNA PLEURA-LT

Facility

$2,403.20

Service Code	HCPCS 10022LT
Hospital Charge Code	2690860
Hospital Revenue Code	361
Min. Negotiated Rate	$360.48
Max. Negotiated Rate	$360.48
Rate for Payer: Qualcare PPO/HMO/WC	$360.48

IR-PERC FNA PLEURA-RT

Facility

$2,403.20

Service Code	HCPCS 10022RT
Hospital Charge Code	2690865
Hospital Revenue Code	361
Min. Negotiated Rate	$57.92
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$913.22
Rate for Payer: Aetna Medicare Advantage	$720.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.82
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	$612.82
Rate for Payer: Cigna Commercial	$1,201.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$720.96
Rate for Payer: Qualcare PPO/HMO/WC	$360.48
Rate for Payer: UnitedHealthcare Community & State	$57.92
Rate for Payer: Wellpoint Medicaid Managed Care	$63.68

IR-PERC FNA PLEURA-RT

Facility

$1,364.00

Service Code	HCPCS 10022RT
Hospital Charge Code	7411858
Hospital Revenue Code	361
Min. Negotiated Rate	$204.60
Max. Negotiated Rate	$204.60
Rate for Payer: Qualcare PPO/HMO/WC	$204.60

IR-PERC FNA PLEURA-RT

Facility

$2,403.20

Service Code	HCPCS 10022RT
Hospital Charge Code	2690865
Hospital Revenue Code	361
Min. Negotiated Rate	$360.48
Max. Negotiated Rate	$360.48
Rate for Payer: Qualcare PPO/HMO/WC	$360.48

IR-PERC FNA PLEURA-RT

Facility

$1,364.00

Service Code	HCPCS 10022RT
Hospital Charge Code	7411858
Hospital Revenue Code	361
Min. Negotiated Rate	$32.87
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$518.32
Rate for Payer: Aetna Medicare Advantage	$409.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$347.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$347.82
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	$347.82
Rate for Payer: Cigna Commercial	$682.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$409.20
Rate for Payer: Qualcare PPO/HMO/WC	$204.60
Rate for Payer: UnitedHealthcare Community & State	$32.87
Rate for Payer: Wellpoint Medicaid Managed Care	$36.15

IR-PERC INJ RENAL CYST-BI

Facility

$7,064.85

Service Code	HCPCS 5039050
Hospital Charge Code	321050390B
Hospital Revenue Code	761
Min. Negotiated Rate	$1,059.73
Max. Negotiated Rate	$1,059.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,059.73

IR-PERC INJ RENAL CYST-BI

Facility

$7,064.85

Service Code	HCPCS 5039050
Hospital Charge Code	411050390B
Hospital Revenue Code	361
Min. Negotiated Rate	$1,059.73
Max. Negotiated Rate	$1,059.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,059.73

IR-PERC INJ RENAL CYST-BI

Facility

$7,064.85

Service Code	HCPCS 5039050
Hospital Charge Code	2690630
Hospital Revenue Code	761
Min. Negotiated Rate	$1,059.73
Max. Negotiated Rate	$1,059.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,059.73

IR-PERC INJ RENAL CYST-BI

Facility

$7,064.85

Service Code	HCPCS 5039050
Hospital Charge Code	411050390B
Hospital Revenue Code	361
Min. Negotiated Rate	$170.26
Max. Negotiated Rate	$3,532.43
Rate for Payer: Aetna Commercial	$2,684.64
Rate for Payer: Aetna Medicare Advantage	$2,119.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,801.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,801.54
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	$1,801.54
Rate for Payer: Cigna Commercial	$3,532.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,119.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,059.73
Rate for Payer: UnitedHealthcare Community & State	$170.26
Rate for Payer: Wellpoint Medicaid Managed Care	$187.22

IR-PERC INJ RENAL CYST-BI

Facility

$7,064.85

Service Code	HCPCS 5039050
Hospital Charge Code	321050390B
Hospital Revenue Code	761
Min. Negotiated Rate	$170.26
Max. Negotiated Rate	$3,532.43
Rate for Payer: Aetna Commercial	$2,684.64
Rate for Payer: Aetna Medicare Advantage	$2,119.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,801.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,801.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,801.54
Rate for Payer: Cigna Commercial	$3,532.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,119.45
Rate for Payer: Oxford Commercial	$1,412.97
Rate for Payer: Qualcare PPO/HMO/WC	$1,059.73
Rate for Payer: UnitedHealthcare Commercial	$1,412.97
Rate for Payer: UnitedHealthcare Community & State	$170.26
Rate for Payer: Wellpoint Medicaid Managed Care	$187.22

IR-PERC INJ RENAL CYST-BI

Facility

$1,541.00

Service Code	HCPCS 5039050
Hospital Charge Code	7411823
Hospital Revenue Code	761
Min. Negotiated Rate	$231.15
Max. Negotiated Rate	$231.15
Rate for Payer: Qualcare PPO/HMO/WC	$231.15

IR-PERC INJ RENAL CYST-BI

Facility

$1,541.00

Service Code	HCPCS 5039050
Hospital Charge Code	7411823
Hospital Revenue Code	761
Min. Negotiated Rate	$37.14
Max. Negotiated Rate	$770.50
Rate for Payer: Aetna Commercial	$585.58
Rate for Payer: Aetna Medicare Advantage	$462.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$392.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$392.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$392.95
Rate for Payer: Cigna Commercial	$770.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$462.30
Rate for Payer: Oxford Commercial	$308.20
Rate for Payer: Qualcare PPO/HMO/WC	$231.15
Rate for Payer: UnitedHealthcare Commercial	$308.20
Rate for Payer: UnitedHealthcare Community & State	$37.14
Rate for Payer: Wellpoint Medicaid Managed Care	$40.84

IR-PERC INJ RENAL CYST-BI

Facility

$7,064.85

Service Code	HCPCS 5039050
Hospital Charge Code	3668503905
Hospital Revenue Code	361
Min. Negotiated Rate	$1,059.73
Max. Negotiated Rate	$1,059.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,059.73

IR-PERC INJ RENAL CYST-BI

Facility

$7,064.85

Service Code	HCPCS 5039050
Hospital Charge Code	2690630
Hospital Revenue Code	761
Min. Negotiated Rate	$170.26
Max. Negotiated Rate	$3,532.43
Rate for Payer: Aetna Commercial	$2,684.64
Rate for Payer: Aetna Medicare Advantage	$2,119.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,801.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,801.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,801.54
Rate for Payer: Cigna Commercial	$3,532.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,119.45
Rate for Payer: Oxford Commercial	$1,412.97
Rate for Payer: Qualcare PPO/HMO/WC	$1,059.73
Rate for Payer: UnitedHealthcare Commercial	$1,412.97
Rate for Payer: UnitedHealthcare Community & State	$170.26
Rate for Payer: Wellpoint Medicaid Managed Care	$187.22

IR-PERC INJ RENAL CYST-BI

Facility

$7,064.85

Service Code	HCPCS 5039050
Hospital Charge Code	3668503905
Hospital Revenue Code	361
Min. Negotiated Rate	$170.26
Max. Negotiated Rate	$3,532.43
Rate for Payer: Aetna Commercial	$2,684.64
Rate for Payer: Aetna Medicare Advantage	$2,119.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,801.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,801.54
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	$1,801.54
Rate for Payer: Cigna Commercial	$3,532.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,119.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,059.73
Rate for Payer: UnitedHealthcare Community & State	$170.26
Rate for Payer: Wellpoint Medicaid Managed Care	$187.22

IR-PERC INJ RENAL CYST-LT

Facility

$1,541.00

Service Code	HCPCS 50390LT
Hospital Charge Code	7411966
Hospital Revenue Code	761
Min. Negotiated Rate	$37.14
Max. Negotiated Rate	$770.50
Rate for Payer: Aetna Commercial	$585.58
Rate for Payer: Aetna Medicare Advantage	$462.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$392.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$392.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$392.95
Rate for Payer: Cigna Commercial	$770.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$462.30
Rate for Payer: Oxford Commercial	$308.20
Rate for Payer: Qualcare PPO/HMO/WC	$231.15
Rate for Payer: UnitedHealthcare Commercial	$308.20
Rate for Payer: UnitedHealthcare Community & State	$37.14
Rate for Payer: Wellpoint Medicaid Managed Care	$40.84

IR-PERC INJ RENAL CYST-LT

Facility

$4,709.90

Service Code	HCPCS 50390LT
Hospital Charge Code	2691590
Hospital Revenue Code	361
Min. Negotiated Rate	$113.51
Max. Negotiated Rate	$2,354.95
Rate for Payer: Aetna Commercial	$1,789.76
Rate for Payer: Aetna Medicare Advantage	$1,412.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,201.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,201.02
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	$1,201.02
Rate for Payer: Cigna Commercial	$2,354.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,412.97
Rate for Payer: Qualcare PPO/HMO/WC	$706.49
Rate for Payer: UnitedHealthcare Community & State	$113.51
Rate for Payer: Wellpoint Medicaid Managed Care	$124.81

Know your out-of-pocket cost for care.

All Charges