Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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	$706.49
Max. Negotiated Rate	$706.49
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

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	$231.15
Max. Negotiated Rate	$231.15
Rate for Payer: Qualcare PPO/HMO/WC	$231.15

IR-PERC INJ RENAL CYST-LT

Facility

$4,709.90

Service Code	HCPCS 50390LT
Hospital Charge Code	411050390L
Hospital Revenue Code	361
Min. Negotiated Rate	$706.49
Max. Negotiated Rate	$706.49
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

IR-PERC INJ RENAL CYST-LT

Facility

$4,709.90

Service Code	HCPCS 50390LT
Hospital Charge Code	321050390L
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

IR-PERC INJ RENAL CYST-LT

Facility

$4,709.90

Service Code	HCPCS 50390LT
Hospital Charge Code	321050390L
Hospital Revenue Code	361
Min. Negotiated Rate	$706.49
Max. Negotiated Rate	$706.49
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

IR-PERC INJ RENAL CYST-LT

Facility

$4,709.90

Service Code	HCPCS 50390LT
Hospital Charge Code	411050390L
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

IR-PERC INJ RENAL CYST-LT

Facility

$4,709.90

Service Code	HCPCS 50390LT
Hospital Charge Code	366850390L
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

IR-PERC INJ RENAL CYST-LT

Facility

$4,709.90

Service Code	HCPCS 50390LT
Hospital Charge Code	366850390L
Hospital Revenue Code	361
Min. Negotiated Rate	$706.49
Max. Negotiated Rate	$706.49
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

IR-PERC INJ RENAL CYST-RT

Facility

$4,709.90

Service Code	HCPCS 50390RT
Hospital Charge Code	411050390R
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

IR-PERC INJ RENAL CYST-RT

Facility

$4,709.90

Service Code	HCPCS 50390RT
Hospital Charge Code	366850390R
Hospital Revenue Code	361
Min. Negotiated Rate	$706.49
Max. Negotiated Rate	$706.49
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

IR-PERC INJ RENAL CYST-RT

Facility

$4,709.90

Service Code	HCPCS 50390RT
Hospital Charge Code	2691595
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

IR-PERC INJ RENAL CYST-RT

Facility

$1,541.00

Service Code	HCPCS 50390RT
Hospital Charge Code	7411967
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-RT

Facility

$1,541.00

Service Code	HCPCS 50390RT
Hospital Charge Code	7411967
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-RT

Facility

$4,709.90

Service Code	HCPCS 50390RT
Hospital Charge Code	411050390R
Hospital Revenue Code	361
Min. Negotiated Rate	$706.49
Max. Negotiated Rate	$706.49
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

IR-PERC INJ RENAL CYST-RT

Facility

$4,709.90

Service Code	HCPCS 50390RT
Hospital Charge Code	321050390R
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

IR-PERC INJ RENAL CYST-RT

Facility

$4,709.90

Service Code	HCPCS 50390RT
Hospital Charge Code	2691595
Hospital Revenue Code	361
Min. Negotiated Rate	$706.49
Max. Negotiated Rate	$706.49
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

IR-PERC INJ RENAL CYST-RT

Facility

$4,709.90

Service Code	HCPCS 50390RT
Hospital Charge Code	321050390R
Hospital Revenue Code	361
Min. Negotiated Rate	$706.49
Max. Negotiated Rate	$706.49
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

IR-PERC INJ RENAL CYST-RT

Facility

$4,709.90

Service Code	HCPCS 50390RT
Hospital Charge Code	366850390R
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

IR PERC NEEDLE CORE BX BREAST

Facility

$1,901.69

Service Code	HCPCS 19100
Hospital Charge Code	2670240
Hospital Revenue Code	361
Min. Negotiated Rate	$285.25
Max. Negotiated Rate	$285.25
Rate for Payer: Qualcare PPO/HMO/WC	$285.25

IR PERC NEEDLE CORE BX BREAST

Facility

$1,901.69

Service Code	HCPCS 19100
Hospital Charge Code	2670240
Hospital Revenue Code	361
Min. Negotiated Rate	$45.83
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
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	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$570.51
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$285.25
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$45.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$50.39

IR PERC NEEDLE CORE BX BREAST

Facility

$1,901.69

Service Code	HCPCS 19100
Hospital Charge Code	7411339
Hospital Revenue Code	361
Min. Negotiated Rate	$285.25
Max. Negotiated Rate	$285.25
Rate for Payer: Qualcare PPO/HMO/WC	$285.25

IR PERC NEEDLE CORE BX BREAST

Facility

$1,901.69

Service Code	HCPCS 19100
Hospital Charge Code	7411339
Hospital Revenue Code	361
Min. Negotiated Rate	$45.83
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
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	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$570.51
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$285.25
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$45.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$50.39

IR PERC PCMT OF DRAIN CATH

Facility

$2,687.00

Hospital Charge Code	2008025
Hospital Revenue Code	320
Min. Negotiated Rate	$403.05
Max. Negotiated Rate	$403.05
Rate for Payer: Qualcare PPO/HMO/WC	$403.05

IR PERC PCMT OF DRAIN CATH

Facility

$2,687.00

Hospital Charge Code	2008025
Hospital Revenue Code	320
Min. Negotiated Rate	$64.76
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,021.06
Rate for Payer: Aetna Medicare Advantage	$806.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$685.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$685.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$685.18
Rate for Payer: Cigna Commercial	$1,343.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$806.10
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$403.05
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$64.76
Rate for Payer: Wellpoint Medicaid Managed Care	$71.21

IR PERC PLACE OF METALLIC CLIP

Facility

$270.60

Hospital Charge Code	26702046
Hospital Revenue Code	361
Min. Negotiated Rate	$40.59
Max. Negotiated Rate	$40.59
Rate for Payer: Qualcare PPO/HMO/WC	$40.59

Know your out-of-pocket cost for care.

All Charges