Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR-REM NEPHROSTOM TUBE-LT

Facility

$3,292.50

Service Code	HCPCS 50389LT
Hospital Charge Code	321050389L
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	411050389L
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

$2,116.00

Service Code	HCPCS 50389LT
Hospital Charge Code	7411964
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-LT

Facility

$3,292.50

Service Code	HCPCS 50389LT
Hospital Charge Code	2691580
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

$2,116.00

Service Code	HCPCS 50389LT
Hospital Charge Code	7411964
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	366850389L
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	366850389L
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-RT

Facility

$3,292.50

Service Code	HCPCS 50389RT
Hospital Charge Code	366850389R
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-RT

Facility

$2,116.00

Service Code	HCPCS 50389RT
Hospital Charge Code	7411965
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-RT

Facility

$3,292.50

Service Code	HCPCS 50389RT
Hospital Charge Code	411050389R
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-RT

Facility

$3,292.50

Service Code	HCPCS 50389RT
Hospital Charge Code	411050389R
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-RT

Facility

$3,292.50

Service Code	HCPCS 50389RT
Hospital Charge Code	366850389R
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-RT

Facility

$2,116.00

Service Code	HCPCS 50389RT
Hospital Charge Code	7411965
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-RT

Facility

$3,292.50

Service Code	HCPCS 50389RT
Hospital Charge Code	321050389R
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-RT

Facility

$3,292.50

Service Code	HCPCS 50389RT
Hospital Charge Code	321050389R
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-RT

Facility

$3,292.50

Service Code	HCPCS 50389RT
Hospital Charge Code	2691585
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-RT

Facility

$3,292.50

Service Code	HCPCS 50389RT
Hospital Charge Code	2691585
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 OBS G/G-J/COLO TUB

Facility

$4,459.55

Service Code	HCPCS 49460
Hospital Charge Code	2690175
Hospital Revenue Code	361
Min. Negotiated Rate	$668.93
Max. Negotiated Rate	$668.93
Rate for Payer: Qualcare PPO/HMO/WC	$668.93

IR-REM OBS G/G-J/COLO TUB

Facility

$4,459.55

Service Code	HCPCS 49460
Hospital Charge Code	2690175
Hospital Revenue Code	361
Min. Negotiated Rate	$107.48
Max. Negotiated Rate	$5,311.00
Rate for Payer: Aetna Commercial	$2,930.85
Rate for Payer: Aetna Medicare Advantage	$3,491.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,077.52
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	$3,889.52
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: Cigna Medicare Advantage	$1,077.52
Rate for Payer: Clover Medicare Advantage	$1,023.64
Rate for Payer: EmblemHealth Commercial	$3,232.56
Rate for Payer: Humana Medicare Advantage	$1,109.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,077.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,337.87
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$668.93
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$107.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,077.52
Rate for Payer: Wellcare Medicare Advantage	$1,077.52
Rate for Payer: Wellpoint Medicaid Managed Care	$118.18

IR-REM OBS G/G-J/COLO TUB

Facility

$3,717.20

Service Code	HCPCS 49460
Hospital Charge Code	366849460
Hospital Revenue Code	361
Min. Negotiated Rate	$557.58
Max. Negotiated Rate	$557.58
Rate for Payer: Qualcare PPO/HMO/WC	$557.58

IR-REM OBS G/G-J/COLO TUB

Facility

$3,717.20

Service Code	HCPCS 49460
Hospital Charge Code	411049460
Hospital Revenue Code	361
Min. Negotiated Rate	$89.58
Max. Negotiated Rate	$5,311.00
Rate for Payer: Aetna Commercial	$2,930.85
Rate for Payer: Aetna Medicare Advantage	$3,491.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,077.52
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	$3,889.52
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: Cigna Medicare Advantage	$1,077.52
Rate for Payer: Clover Medicare Advantage	$1,023.64
Rate for Payer: EmblemHealth Commercial	$3,232.56
Rate for Payer: Humana Medicare Advantage	$1,109.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,077.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,115.16
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$557.58
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$89.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,077.52
Rate for Payer: Wellcare Medicare Advantage	$1,077.52
Rate for Payer: Wellpoint Medicaid Managed Care	$98.51

IR-REM OBS G/G-J/COLO TUB

Facility

$4,459.55

Service Code	HCPCS 49460
Hospital Charge Code	321049460
Hospital Revenue Code	361
Min. Negotiated Rate	$668.93
Max. Negotiated Rate	$668.93
Rate for Payer: Qualcare PPO/HMO/WC	$668.93

IR-REM OBS G/G-J/COLO TUB

Facility

$3,717.20

Service Code	HCPCS 49460
Hospital Charge Code	411049460
Hospital Revenue Code	361
Min. Negotiated Rate	$557.58
Max. Negotiated Rate	$557.58
Rate for Payer: Qualcare PPO/HMO/WC	$557.58

IR-REM OBS G/G-J/COLO TUB

Facility

$1,892.00

Service Code	HCPCS 49460
Hospital Charge Code	7411600
Hospital Revenue Code	361
Min. Negotiated Rate	$283.80
Max. Negotiated Rate	$283.80
Rate for Payer: Qualcare PPO/HMO/WC	$283.80

IR-REM OBS G/G-J/COLO TUB

Facility

$1,892.00

Service Code	HCPCS 49460
Hospital Charge Code	7411600
Hospital Revenue Code	361
Min. Negotiated Rate	$45.60
Max. Negotiated Rate	$5,311.00
Rate for Payer: Aetna Commercial	$2,930.85
Rate for Payer: Aetna Medicare Advantage	$3,491.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,077.52
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	$3,889.52
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: Cigna Medicare Advantage	$1,077.52
Rate for Payer: Clover Medicare Advantage	$1,023.64
Rate for Payer: EmblemHealth Commercial	$3,232.56
Rate for Payer: Humana Medicare Advantage	$1,109.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,077.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$567.60
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$283.80
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$45.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,077.52
Rate for Payer: Wellcare Medicare Advantage	$1,077.52
Rate for Payer: Wellpoint Medicaid Managed Care	$50.14

Know your out-of-pocket cost for care.

All Charges