Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR-REM INT URET STENT-BI

Facility

$14,912.20

Service Code	HCPCS 5038450
Hospital Charge Code	321050384B
Hospital Revenue Code	361
Min. Negotiated Rate	$359.38
Max. Negotiated Rate	$7,456.10
Rate for Payer: Aetna Commercial	$5,666.64
Rate for Payer: Aetna Medicare Advantage	$4,473.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,802.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,802.61
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	$3,802.61
Rate for Payer: Cigna Commercial	$7,456.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,473.66
Rate for Payer: Qualcare PPO/HMO/WC	$2,236.83
Rate for Payer: UnitedHealthcare Community & State	$359.38
Rate for Payer: Wellpoint Medicaid Managed Care	$395.17

IR-REM INT URET STENT-BI

Facility

$14,912.20

Service Code	HCPCS 5038450
Hospital Charge Code	2690615
Hospital Revenue Code	361
Min. Negotiated Rate	$359.38
Max. Negotiated Rate	$7,456.10
Rate for Payer: Aetna Commercial	$5,666.64
Rate for Payer: Aetna Medicare Advantage	$4,473.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,802.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,802.61
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	$3,802.61
Rate for Payer: Cigna Commercial	$7,456.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,473.66
Rate for Payer: Qualcare PPO/HMO/WC	$2,236.83
Rate for Payer: UnitedHealthcare Community & State	$359.38
Rate for Payer: Wellpoint Medicaid Managed Care	$395.17

IR-REM INT URET STENT-BI

Facility

$5,055.00

Service Code	HCPCS 5038450
Hospital Charge Code	7411820
Hospital Revenue Code	361
Min. Negotiated Rate	$121.83
Max. Negotiated Rate	$2,527.50
Rate for Payer: Aetna Commercial	$1,920.90
Rate for Payer: Aetna Medicare Advantage	$1,516.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,289.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,289.03
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	$1,289.03
Rate for Payer: Cigna Commercial	$2,527.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,516.50
Rate for Payer: Qualcare PPO/HMO/WC	$758.25
Rate for Payer: UnitedHealthcare Community & State	$121.83
Rate for Payer: Wellpoint Medicaid Managed Care	$133.96

IR-REM INT URET STENT-BI

Facility

$14,912.20

Service Code	HCPCS 5038450
Hospital Charge Code	321050384B
Hospital Revenue Code	361
Min. Negotiated Rate	$2,236.83
Max. Negotiated Rate	$2,236.83
Rate for Payer: Qualcare PPO/HMO/WC	$2,236.83

IR-REM INT URET STENT-BI

Facility

$5,055.00

Service Code	HCPCS 5038450
Hospital Charge Code	7411820
Hospital Revenue Code	361
Min. Negotiated Rate	$758.25
Max. Negotiated Rate	$758.25
Rate for Payer: Qualcare PPO/HMO/WC	$758.25

IR-REM INT URET STENT-BI

Facility

$14,912.20

Service Code	HCPCS 5038450
Hospital Charge Code	2690615
Hospital Revenue Code	361
Min. Negotiated Rate	$2,236.83
Max. Negotiated Rate	$2,236.83
Rate for Payer: Qualcare PPO/HMO/WC	$2,236.83

IR-REM INT URET STENT-LT

Facility

$5,475.00

Service Code	HCPCS 50384LT
Hospital Charge Code	7411960
Hospital Revenue Code	361
Min. Negotiated Rate	$131.95
Max. Negotiated Rate	$2,737.50
Rate for Payer: Aetna Commercial	$2,080.50
Rate for Payer: Aetna Medicare Advantage	$1,642.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,396.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,396.12
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	$1,396.12
Rate for Payer: Cigna Commercial	$2,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,642.50
Rate for Payer: Qualcare PPO/HMO/WC	$821.25
Rate for Payer: UnitedHealthcare Community & State	$131.95
Rate for Payer: Wellpoint Medicaid Managed Care	$145.09

IR-REM INT URET STENT-LT

Facility

$5,475.00

Service Code	HCPCS 50384LT
Hospital Charge Code	7411960
Hospital Revenue Code	361
Min. Negotiated Rate	$821.25
Max. Negotiated Rate	$821.25
Rate for Payer: Qualcare PPO/HMO/WC	$821.25

IR-REM INT URET STENT-LT

Facility

$10,187.80

Service Code	HCPCS 50384LT
Hospital Charge Code	2691560
Hospital Revenue Code	361
Min. Negotiated Rate	$245.53
Max. Negotiated Rate	$5,093.90
Rate for Payer: Aetna Commercial	$3,871.36
Rate for Payer: Aetna Medicare Advantage	$3,056.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,597.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,597.89
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	$2,597.89
Rate for Payer: Cigna Commercial	$5,093.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,056.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17
Rate for Payer: UnitedHealthcare Community & State	$245.53
Rate for Payer: Wellpoint Medicaid Managed Care	$269.98

IR-REM INT URET STENT-LT

Facility

$10,187.80

Service Code	HCPCS 50384LT
Hospital Charge Code	321050384L
Hospital Revenue Code	361
Min. Negotiated Rate	$1,528.17
Max. Negotiated Rate	$1,528.17
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17

IR-REM INT URET STENT-LT

Facility

$10,187.80

Service Code	HCPCS 50384LT
Hospital Charge Code	2691560
Hospital Revenue Code	361
Min. Negotiated Rate	$1,528.17
Max. Negotiated Rate	$1,528.17
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17

IR-REM INT URET STENT-LT

Facility

$10,187.80

Service Code	HCPCS 50384LT
Hospital Charge Code	321050384L
Hospital Revenue Code	361
Min. Negotiated Rate	$245.53
Max. Negotiated Rate	$5,093.90
Rate for Payer: Aetna Commercial	$3,871.36
Rate for Payer: Aetna Medicare Advantage	$3,056.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,597.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,597.89
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	$2,597.89
Rate for Payer: Cigna Commercial	$5,093.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,056.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17
Rate for Payer: UnitedHealthcare Community & State	$245.53
Rate for Payer: Wellpoint Medicaid Managed Care	$269.98

IR-REM INT URET STENT-RT

Facility

$10,187.80

Service Code	HCPCS 50384RT
Hospital Charge Code	2691565
Hospital Revenue Code	361
Min. Negotiated Rate	$1,528.17
Max. Negotiated Rate	$1,528.17
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17

IR-REM INT URET STENT-RT

Facility

$10,187.80

Service Code	HCPCS 50384RT
Hospital Charge Code	2691565
Hospital Revenue Code	361
Min. Negotiated Rate	$245.53
Max. Negotiated Rate	$5,093.90
Rate for Payer: Aetna Commercial	$3,871.36
Rate for Payer: Aetna Medicare Advantage	$3,056.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,597.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,597.89
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	$2,597.89
Rate for Payer: Cigna Commercial	$5,093.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,056.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17
Rate for Payer: UnitedHealthcare Community & State	$245.53
Rate for Payer: Wellpoint Medicaid Managed Care	$269.98

IR-REM INT URET STENT-RT

Facility

$5,475.00

Service Code	HCPCS 50384RT
Hospital Charge Code	7411961
Hospital Revenue Code	361
Min. Negotiated Rate	$131.95
Max. Negotiated Rate	$2,737.50
Rate for Payer: Aetna Commercial	$2,080.50
Rate for Payer: Aetna Medicare Advantage	$1,642.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,396.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,396.12
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	$1,396.12
Rate for Payer: Cigna Commercial	$2,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,642.50
Rate for Payer: Qualcare PPO/HMO/WC	$821.25
Rate for Payer: UnitedHealthcare Community & State	$131.95
Rate for Payer: Wellpoint Medicaid Managed Care	$145.09

IR-REM INT URET STENT-RT

Facility

$5,475.00

Service Code	HCPCS 50384RT
Hospital Charge Code	7411961
Hospital Revenue Code	361
Min. Negotiated Rate	$821.25
Max. Negotiated Rate	$821.25
Rate for Payer: Qualcare PPO/HMO/WC	$821.25

IR-REM INT URET STENT-RT

Facility

$10,187.80

Service Code	HCPCS 50384RT
Hospital Charge Code	321050384R
Hospital Revenue Code	361
Min. Negotiated Rate	$1,528.17
Max. Negotiated Rate	$1,528.17
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17

IR-REM INT URET STENT-RT

Facility

$10,187.80

Service Code	HCPCS 50384RT
Hospital Charge Code	321050384R
Hospital Revenue Code	361
Min. Negotiated Rate	$245.53
Max. Negotiated Rate	$5,093.90
Rate for Payer: Aetna Commercial	$3,871.36
Rate for Payer: Aetna Medicare Advantage	$3,056.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,597.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,597.89
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	$2,597.89
Rate for Payer: Cigna Commercial	$5,093.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,056.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17
Rate for Payer: UnitedHealthcare Community & State	$245.53
Rate for Payer: Wellpoint Medicaid Managed Care	$269.98

IR-REM NEPHROSTOM TUBE-BI

Facility

$2,116.00

Service Code	HCPCS 5038950
Hospital Charge Code	7411822
Hospital Revenue Code	361
Min. Negotiated Rate	$317.40
Max. Negotiated Rate	$317.40
Rate for Payer: Qualcare PPO/HMO/WC	$317.40

IR-REM NEPHROSTOM TUBE-BI

Facility

$2,116.00

Service Code	HCPCS 5038950
Hospital Charge Code	2690625
Hospital Revenue Code	361
Min. Negotiated Rate	$317.40
Max. Negotiated Rate	$317.40
Rate for Payer: Qualcare PPO/HMO/WC	$317.40

IR-REM NEPHROSTOM TUBE-BI

Facility

$2,116.00

Service Code	HCPCS 5038950
Hospital Charge Code	2690625
Hospital Revenue Code	361
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$804.08
Rate for Payer: Aetna Medicare Advantage	$634.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$539.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$539.58
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	$539.58
Rate for Payer: Cigna Commercial	$1,058.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$634.80
Rate for Payer: Qualcare PPO/HMO/WC	$317.40
Rate for Payer: UnitedHealthcare Community & State	$51.00
Rate for Payer: Wellpoint Medicaid Managed Care	$56.07

IR-REM NEPHROSTOM TUBE-BI

Facility

$2,116.00

Service Code	HCPCS 5038950
Hospital Charge Code	7411822
Hospital Revenue Code	361
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$804.08
Rate for Payer: Aetna Medicare Advantage	$634.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$539.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$539.58
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	$539.58
Rate for Payer: Cigna Commercial	$1,058.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$634.80
Rate for Payer: Qualcare PPO/HMO/WC	$317.40
Rate for Payer: UnitedHealthcare Community & State	$51.00
Rate for Payer: Wellpoint Medicaid Managed Care	$56.07

IR-REM NEPHROSTOM TUBE-LT

Facility

$3,292.50

Service Code	HCPCS 50389LT
Hospital Charge Code	411050389L
Hospital Revenue Code	361
Min. Negotiated Rate	$493.88
Max. Negotiated Rate	$493.88
Rate for Payer: Qualcare PPO/HMO/WC	$493.88

IR-REM NEPHROSTOM TUBE-LT

Facility

$3,292.50

Service Code	HCPCS 50389LT
Hospital Charge Code	2691580
Hospital Revenue Code	361
Min. Negotiated Rate	$79.35
Max. Negotiated Rate	$1,646.25
Rate for Payer: Aetna Commercial	$1,251.15
Rate for Payer: Aetna Medicare Advantage	$987.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$839.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$839.59
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	$839.59
Rate for Payer: Cigna Commercial	$1,646.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$987.75
Rate for Payer: Qualcare PPO/HMO/WC	$493.88
Rate for Payer: UnitedHealthcare Community & State	$79.35
Rate for Payer: Wellpoint Medicaid Managed Care	$87.25

IR-REM NEPHROSTOM TUBE-LT

Facility

$3,292.50

Service Code	HCPCS 50389LT
Hospital Charge Code	321050389L
Hospital Revenue Code	361
Min. Negotiated Rate	$493.88
Max. Negotiated Rate	$493.88
Rate for Payer: Qualcare PPO/HMO/WC	$493.88

Know your out-of-pocket cost for care.

All Charges