Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR-REM TUN PLEURL CATH-RT

Facility

$1,194.00

Service Code	HCPCS 32551RT
Hospital Charge Code	7411886
Hospital Revenue Code	361
Min. Negotiated Rate	$179.10
Max. Negotiated Rate	$179.10
Rate for Payer: Qualcare PPO/HMO/WC	$179.10

IR REMV/NEPHROSTOMY TUBE FL G

Facility

$3,042.00

Service Code	HCPCS 50389
Hospital Charge Code	7411603
Hospital Revenue Code	361
Min. Negotiated Rate	$456.30
Max. Negotiated Rate	$456.30
Rate for Payer: Qualcare PPO/HMO/WC	$456.30

IR REMV/NEPHROSTOMY TUBE FL G

Facility

$3,042.00

Service Code	HCPCS 50389
Hospital Charge Code	2680210
Hospital Revenue Code	361
Min. Negotiated Rate	$73.31
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,253.28
Rate for Payer: Aetna Medicare Advantage	$2,684.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,990.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,990.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$828.41
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	$2,990.31
Rate for Payer: Cigna Commercial	$1,660.53
Rate for Payer: Cigna Medicare Advantage	$828.41
Rate for Payer: Clover Medicare Advantage	$786.99
Rate for Payer: EmblemHealth Commercial	$2,485.23
Rate for Payer: Humana Medicare Advantage	$853.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$828.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$912.60
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$456.30
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$73.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$828.41
Rate for Payer: Wellcare Medicare Advantage	$828.41
Rate for Payer: Wellpoint Medicaid Managed Care	$80.61

IR REMV/NEPHROSTOMY TUBE FL G

Facility

$3,042.00

Service Code	HCPCS 50389
Hospital Charge Code	2680210
Hospital Revenue Code	361
Min. Negotiated Rate	$456.30
Max. Negotiated Rate	$456.30
Rate for Payer: Qualcare PPO/HMO/WC	$456.30

IR REMV/NEPHROSTOMY TUBE FL G

Facility

$3,042.00

Service Code	HCPCS 50389
Hospital Charge Code	7411603
Hospital Revenue Code	361
Min. Negotiated Rate	$73.31
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,253.28
Rate for Payer: Aetna Medicare Advantage	$2,684.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,990.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,990.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$828.41
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	$2,990.31
Rate for Payer: Cigna Commercial	$1,660.53
Rate for Payer: Cigna Medicare Advantage	$828.41
Rate for Payer: Clover Medicare Advantage	$786.99
Rate for Payer: EmblemHealth Commercial	$2,485.23
Rate for Payer: Humana Medicare Advantage	$853.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$828.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$912.60
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$456.30
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$73.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$828.41
Rate for Payer: Wellcare Medicare Advantage	$828.41
Rate for Payer: Wellpoint Medicaid Managed Care	$80.61

IR-RENAL ABSCESS DRAIN-BI

Facility

$2,522.00

Service Code	HCPCS 5002150
Hospital Charge Code	2690600
Hospital Revenue Code	361
Min. Negotiated Rate	$378.30
Max. Negotiated Rate	$378.30
Rate for Payer: Qualcare PPO/HMO/WC	$378.30

IR-RENAL ABSCESS DRAIN-BI

Facility

$2,522.00

Service Code	HCPCS 5002150
Hospital Charge Code	2690600
Hospital Revenue Code	361
Min. Negotiated Rate	$60.78
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$958.36
Rate for Payer: Aetna Medicare Advantage	$756.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$643.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$643.11
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	$643.11
Rate for Payer: Cigna Commercial	$1,261.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$756.60
Rate for Payer: Qualcare PPO/HMO/WC	$378.30
Rate for Payer: UnitedHealthcare Community & State	$60.78
Rate for Payer: Wellpoint Medicaid Managed Care	$66.83

IR-RENAL BIOPS,PERCT,TROCAR,ND

Facility

$7,071.40

Service Code	HCPCS 50200
Hospital Charge Code	7411602
Hospital Revenue Code	361
Min. Negotiated Rate	$1,060.71
Max. Negotiated Rate	$1,060.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,060.71

IR-RENAL BIOPS,PERCT,TROCAR,ND

Facility

$7,071.40

Service Code	HCPCS 50200
Hospital Charge Code	7411602
Hospital Revenue Code	361
Min. Negotiated Rate	$170.42
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	$2,121.42
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,060.71
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$170.42
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	$187.39

IR-RENAL BIOPS,PERCT,TROCAR,ND

Facility

$7,071.40

Service Code	HCPCS 50200
Hospital Charge Code	2680205
Hospital Revenue Code	361
Min. Negotiated Rate	$170.42
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	$2,121.42
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,060.71
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$170.42
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	$187.39

IR-RENAL BIOPS,PERCT,TROCAR,ND

Facility

$7,071.40

Service Code	HCPCS 50200
Hospital Charge Code	2680205
Hospital Revenue Code	361
Min. Negotiated Rate	$1,060.71
Max. Negotiated Rate	$1,060.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,060.71

IR RENAL CTHTER PERC PLCMT LFT

Facility

$2,217.65

Service Code	HCPCS 74475
Hospital Charge Code	2600108
Hospital Revenue Code	320
Min. Negotiated Rate	$53.45
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$842.71
Rate for Payer: Aetna Medicare Advantage	$665.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$565.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$565.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$565.50
Rate for Payer: Cigna Commercial	$1,108.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.29
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$332.65
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$53.45
Rate for Payer: Wellpoint Medicaid Managed Care	$58.77

IR RENAL CTHTER PERC PLCMT LFT

Facility

$2,217.65

Service Code	HCPCS 74475
Hospital Charge Code	2600108
Hospital Revenue Code	320
Min. Negotiated Rate	$332.65
Max. Negotiated Rate	$332.65
Rate for Payer: Qualcare PPO/HMO/WC	$332.65

IR RENAL CTHTER PERC PLCMT RGH

Facility

$2,217.65

Service Code	HCPCS 74475
Hospital Charge Code	2600109
Hospital Revenue Code	320
Min. Negotiated Rate	$332.65
Max. Negotiated Rate	$332.65
Rate for Payer: Qualcare PPO/HMO/WC	$332.65

IR RENAL CTHTER PERC PLCMT RGH

Facility

$2,217.65

Service Code	HCPCS 74475
Hospital Charge Code	2600109
Hospital Revenue Code	320
Min. Negotiated Rate	$53.45
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$842.71
Rate for Payer: Aetna Medicare Advantage	$665.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$565.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$565.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$565.50
Rate for Payer: Cigna Commercial	$1,108.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.29
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$332.65
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$53.45
Rate for Payer: Wellpoint Medicaid Managed Care	$58.77

IR RENAL CYST ASPIRATION PERC

Facility

$3,392.55

Service Code	HCPCS 50390
Hospital Charge Code	2004091
Hospital Revenue Code	361
Min. Negotiated Rate	$81.76
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,036.77
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,017.76
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$508.88
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$81.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$89.90

IR RENAL CYST ASPIRATION PERC

Facility

$4,709.90

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

IR RENAL CYST ASPIRATION PERC

Facility

$4,709.90

Service Code	HCPCS 50390
Hospital Charge Code	7411604
Hospital Revenue Code	361
Min. Negotiated Rate	$113.51
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,036.77
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,412.97
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$706.49
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$113.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$124.81

IR RENAL CYST ASPIRATION PERC

Facility

$4,709.90

Service Code	HCPCS 50390
Hospital Charge Code	411050390
Hospital Revenue Code	361
Min. Negotiated Rate	$113.51
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,036.77
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,412.97
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$706.49
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$113.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$124.81

IR RENAL CYST ASPIRATION PERC

Facility

$4,709.90

Service Code	HCPCS 50390
Hospital Charge Code	7411604
Hospital Revenue Code	361
Min. Negotiated Rate	$706.49
Max. Negotiated Rate	$706.49
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

IR RENAL CYST ASPIRATION PERC

Facility

$4,709.90

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

IR RENAL CYST ASPIRATION PERC

Facility

$3,392.55

Service Code	HCPCS 50390
Hospital Charge Code	321050390
Hospital Revenue Code	361
Min. Negotiated Rate	$508.88
Max. Negotiated Rate	$508.88
Rate for Payer: Qualcare PPO/HMO/WC	$508.88

IR RENAL CYST ASPIRATION PERC

Facility

$4,709.90

Service Code	HCPCS 50390
Hospital Charge Code	366850390
Hospital Revenue Code	361
Min. Negotiated Rate	$113.51
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,036.77
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,412.97
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$706.49
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$113.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$124.81

IR RENAL CYST ASPIRATION PERC

Facility

$3,392.55

Service Code	HCPCS 50390
Hospital Charge Code	321050390
Hospital Revenue Code	361
Min. Negotiated Rate	$81.76
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,036.77
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,017.76
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$508.88
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$81.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$89.90

IR RENAL CYST ASPIRATION PERC

Facility

$3,392.55

Service Code	HCPCS 50390
Hospital Charge Code	2004091
Hospital Revenue Code	361
Min. Negotiated Rate	$508.88
Max. Negotiated Rate	$508.88
Rate for Payer: Qualcare PPO/HMO/WC	$508.88

Know your out-of-pocket cost for care.

All Charges