Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR RENAL CYST ASP PERC BI

Facility

$7,064.85

Service Code	HCPCS 5039050
Hospital Charge Code	7412053
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 RENAL CYST ASP PERC BI

Facility

$7,064.85

Service Code	HCPCS 5039050
Hospital Charge Code	7412053
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 RENAL CYST ASP PERC LT

Facility

$4,709.90

Service Code	HCPCS 50390LT
Hospital Charge Code	7412054
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 RENAL CYST ASP PERC LT

Facility

$4,709.90

Service Code	HCPCS 50390LT
Hospital Charge Code	7412054
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 ASP PERC RT

Facility

$4,709.90

Service Code	HCPCS 50390RT
Hospital Charge Code	7412055
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 RENAL CYST ASP PERC RT

Facility

$4,709.90

Service Code	HCPCS 50390RT
Hospital Charge Code	7412055
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 PUNCTURE

Facility

$664.85

Service Code	HCPCS 74470
Hospital Charge Code	2001600
Hospital Revenue Code	320
Min. Negotiated Rate	$16.02
Max. Negotiated Rate	$2,343.27
Rate for Payer: Aetna Commercial	$1,765.72
Rate for Payer: Aetna Medicare Advantage	$2,103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,343.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,343.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$649.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,343.27
Rate for Payer: Cigna Commercial	$1,301.24
Rate for Payer: Cigna Medicare Advantage	$454.41
Rate for Payer: Clover Medicare Advantage	$616.70
Rate for Payer: EmblemHealth Commercial	$1,947.48
Rate for Payer: Humana Medicare Advantage	$668.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$649.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$199.46
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.73
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$16.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$649.16
Rate for Payer: Wellcare Medicare Advantage	$649.16
Rate for Payer: Wellpoint Medicaid Managed Care	$17.62

IR RENAL CYST PUNCTURE

Facility

$664.85

Service Code	HCPCS 74470
Hospital Charge Code	2001600
Hospital Revenue Code	320
Min. Negotiated Rate	$99.73
Max. Negotiated Rate	$99.73
Rate for Payer: Qualcare PPO/HMO/WC	$99.73

IR RENAL CYST STUDY TRANSLUM W

Facility

$664.85

Service Code	HCPCS 74470
Hospital Charge Code	2004760
Hospital Revenue Code	320
Min. Negotiated Rate	$16.02
Max. Negotiated Rate	$2,343.27
Rate for Payer: Aetna Commercial	$1,765.72
Rate for Payer: Aetna Medicare Advantage	$2,103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,343.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,343.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$649.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,343.27
Rate for Payer: Cigna Commercial	$1,301.24
Rate for Payer: Cigna Medicare Advantage	$454.41
Rate for Payer: Clover Medicare Advantage	$616.70
Rate for Payer: EmblemHealth Commercial	$1,947.48
Rate for Payer: Humana Medicare Advantage	$668.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$649.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$199.46
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.73
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$16.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$649.16
Rate for Payer: Wellcare Medicare Advantage	$649.16
Rate for Payer: Wellpoint Medicaid Managed Care	$17.62

IR RENAL CYST STUDY TRANSLUM W

Facility

$664.85

Service Code	HCPCS 74470
Hospital Charge Code	2004760
Hospital Revenue Code	320
Min. Negotiated Rate	$99.73
Max. Negotiated Rate	$99.73
Rate for Payer: Qualcare PPO/HMO/WC	$99.73

IR RENAL PELVIS DRAINAGE PERC

Facility

$3,730.45

Service Code	HCPCS 50392
Hospital Charge Code	2004521
Hospital Revenue Code	361
Min. Negotiated Rate	$89.90
Max. Negotiated Rate	$1,865.22
Rate for Payer: Aetna Commercial	$1,417.57
Rate for Payer: Aetna Medicare Advantage	$1,119.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$951.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$951.26
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	$951.26
Rate for Payer: Cigna Commercial	$1,865.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,119.13
Rate for Payer: Qualcare PPO/HMO/WC	$559.57
Rate for Payer: UnitedHealthcare Community & State	$89.90
Rate for Payer: Wellpoint Medicaid Managed Care	$98.86

IR RENAL PELVIS DRAINAGE PERC

Facility

$3,730.45

Service Code	HCPCS 50392
Hospital Charge Code	2004521
Hospital Revenue Code	361
Min. Negotiated Rate	$559.57
Max. Negotiated Rate	$559.57
Rate for Payer: Qualcare PPO/HMO/WC	$559.57

IR-RENAL/PERIREN ABCES-LT

Facility

$4,600.00

Service Code	HCPCS 50021LT
Hospital Charge Code	2691530
Hospital Revenue Code	361
Min. Negotiated Rate	$690.00
Max. Negotiated Rate	$690.00
Rate for Payer: Qualcare PPO/HMO/WC	$690.00

IR-RENAL/PERIREN ABCES-LT

Facility

$4,600.00

Service Code	HCPCS 50021LT
Hospital Charge Code	2691530
Hospital Revenue Code	361
Min. Negotiated Rate	$110.86
Max. Negotiated Rate	$2,300.00
Rate for Payer: Aetna Commercial	$1,748.00
Rate for Payer: Aetna Medicare Advantage	$1,380.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,173.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,173.00
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	$1,173.00
Rate for Payer: Cigna Commercial	$2,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,380.00
Rate for Payer: Qualcare PPO/HMO/WC	$690.00
Rate for Payer: UnitedHealthcare Community & State	$110.86
Rate for Payer: Wellpoint Medicaid Managed Care	$121.90

IR-RENAL/PERIREN ABCES-RT

Facility

$4,600.00

Service Code	HCPCS 50021RT
Hospital Charge Code	2691535
Hospital Revenue Code	361
Min. Negotiated Rate	$110.86
Max. Negotiated Rate	$2,300.00
Rate for Payer: Aetna Commercial	$1,748.00
Rate for Payer: Aetna Medicare Advantage	$1,380.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,173.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,173.00
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	$1,173.00
Rate for Payer: Cigna Commercial	$2,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,380.00
Rate for Payer: Qualcare PPO/HMO/WC	$690.00
Rate for Payer: UnitedHealthcare Community & State	$110.86
Rate for Payer: Wellpoint Medicaid Managed Care	$121.90

IR-RENAL/PERIREN ABCES-RT

Facility

$4,600.00

Service Code	HCPCS 50021RT
Hospital Charge Code	2691535
Hospital Revenue Code	361
Min. Negotiated Rate	$690.00
Max. Negotiated Rate	$690.00
Rate for Payer: Qualcare PPO/HMO/WC	$690.00

IR RENAL/VISCERAL PTA

Facility

$21,962.30

Service Code	HCPCS 35471
Hospital Charge Code	5600014
Hospital Revenue Code	361
Min. Negotiated Rate	$529.29
Max. Negotiated Rate	$10,981.15
Rate for Payer: Aetna Commercial	$8,345.67
Rate for Payer: Aetna Medicare Advantage	$6,588.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.39
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	$5,600.39
Rate for Payer: Cigna Commercial	$10,981.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,588.69
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34
Rate for Payer: UnitedHealthcare Community & State	$529.29
Rate for Payer: Wellpoint Medicaid Managed Care	$582.00

IR RENAL/VISCERAL PTA

Facility

$21,962.30

Service Code	HCPCS 35471
Hospital Charge Code	5600014
Hospital Revenue Code	361
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

IR RENAL/VISCERAL PTA

Facility

$21,962.30

Service Code	HCPCS 35471
Hospital Charge Code	7411407
Hospital Revenue Code	361
Min. Negotiated Rate	$529.29
Max. Negotiated Rate	$10,981.15
Rate for Payer: Aetna Commercial	$8,345.67
Rate for Payer: Aetna Medicare Advantage	$6,588.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.39
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	$5,600.39
Rate for Payer: Cigna Commercial	$10,981.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,588.69
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34
Rate for Payer: UnitedHealthcare Community & State	$529.29
Rate for Payer: Wellpoint Medicaid Managed Care	$582.00

IR RENAL/VISCERAL PTA

Facility

$21,962.30

Service Code	HCPCS 35471
Hospital Charge Code	7411407
Hospital Revenue Code	361
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

IR REPAIR ARTERIAL BLOCK (BRA)

Facility

$11,253.65

Service Code	HCPCS 35458
Hospital Charge Code	2011282
Hospital Revenue Code	361
Min. Negotiated Rate	$1,688.05
Max. Negotiated Rate	$1,688.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,688.05

IR REPAIR ARTERIAL BLOCK (BRA)

Facility

$11,253.65

Service Code	HCPCS 35458
Hospital Charge Code	2011282
Hospital Revenue Code	361
Min. Negotiated Rate	$271.21
Max. Negotiated Rate	$5,626.82
Rate for Payer: Aetna Commercial	$4,276.39
Rate for Payer: Aetna Medicare Advantage	$3,376.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,869.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,869.68
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	$2,869.68
Rate for Payer: Cigna Commercial	$5,626.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,376.09
Rate for Payer: Qualcare PPO/HMO/WC	$1,688.05
Rate for Payer: UnitedHealthcare Community & State	$271.21
Rate for Payer: Wellpoint Medicaid Managed Care	$298.22

IR REPAIR ARTERIAL BLOCK (BRA)

Facility

$11,253.65

Service Code	HCPCS 35458
Hospital Charge Code	7411404
Hospital Revenue Code	361
Min. Negotiated Rate	$271.21
Max. Negotiated Rate	$5,626.82
Rate for Payer: Aetna Commercial	$4,276.39
Rate for Payer: Aetna Medicare Advantage	$3,376.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,869.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,869.68
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	$2,869.68
Rate for Payer: Cigna Commercial	$5,626.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,376.09
Rate for Payer: Qualcare PPO/HMO/WC	$1,688.05
Rate for Payer: UnitedHealthcare Community & State	$271.21
Rate for Payer: Wellpoint Medicaid Managed Care	$298.22

IR REPAIR ARTERIAL BLOCK (BRA)

Facility

$11,253.65

Service Code	HCPCS 35458
Hospital Charge Code	7411404
Hospital Revenue Code	361
Min. Negotiated Rate	$1,688.05
Max. Negotiated Rate	$1,688.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,688.05

IR REPAIR ARTERY BLOCKAGE, EA

Facility

$1,547.25

Service Code	HCPCS 75964
Hospital Charge Code	2011280
Hospital Revenue Code	320
Min. Negotiated Rate	$37.29
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$587.96
Rate for Payer: Aetna Medicare Advantage	$464.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$394.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$394.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$394.55
Rate for Payer: Cigna Commercial	$773.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$464.18
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.09
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$37.29
Rate for Payer: Wellpoint Medicaid Managed Care	$41.00

Know your out-of-pocket cost for care.

All Charges