Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR-REVIS/REINSERTION TRANS TUB

Facility

$6,757.27

Hospital Charge Code	2670165
Hospital Revenue Code	361
Min. Negotiated Rate	$1,013.59
Max. Negotiated Rate	$1,013.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,013.59

IR-REVIS/REINSERTION TRANS TUB

Facility

$6,757.27

Hospital Charge Code	2670165
Hospital Revenue Code	361
Min. Negotiated Rate	$162.85
Max. Negotiated Rate	$3,378.64
Rate for Payer: Aetna Commercial	$2,567.76
Rate for Payer: Aetna Medicare Advantage	$2,027.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,723.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,723.10
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	$1,723.10
Rate for Payer: Cigna Commercial	$3,378.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,027.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,013.59
Rate for Payer: UnitedHealthcare Community & State	$162.85
Rate for Payer: Wellpoint Medicaid Managed Care	$179.07

IR REVSC OPN/PRQ TIB/PERO STEN

Facility

$22,441.40

Service Code	HCPCS 37234
Hospital Charge Code	321037234
Hospital Revenue Code	361
Min. Negotiated Rate	$540.84
Max. Negotiated Rate	$14,834.00
Rate for Payer: Aetna Commercial	$8,527.73
Rate for Payer: Aetna Medicare Advantage	$6,732.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,722.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,722.56
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	$5,722.56
Rate for Payer: Cigna Commercial	$11,220.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,732.42
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$540.84
Rate for Payer: Wellpoint Medicaid Managed Care	$594.70

IR REVSC OPN/PRQ TIB/PERO STEN

Facility

$22,441.40

Service Code	HCPCS 37234
Hospital Charge Code	5600215
Hospital Revenue Code	361
Min. Negotiated Rate	$3,366.21
Max. Negotiated Rate	$3,366.21
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21

IR REVSC OPN/PRQ TIB/PERO STEN

Facility

$22,441.40

Service Code	HCPCS 37234
Hospital Charge Code	7411524
Hospital Revenue Code	361
Min. Negotiated Rate	$540.84
Max. Negotiated Rate	$14,834.00
Rate for Payer: Aetna Commercial	$8,527.73
Rate for Payer: Aetna Medicare Advantage	$6,732.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,722.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,722.56
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	$5,722.56
Rate for Payer: Cigna Commercial	$11,220.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,732.42
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$540.84
Rate for Payer: Wellpoint Medicaid Managed Care	$594.70

IR REVSC OPN/PRQ TIB/PERO STEN

Facility

$22,441.40

Service Code	HCPCS 37234
Hospital Charge Code	5600215
Hospital Revenue Code	361
Min. Negotiated Rate	$540.84
Max. Negotiated Rate	$14,834.00
Rate for Payer: Aetna Commercial	$8,527.73
Rate for Payer: Aetna Medicare Advantage	$6,732.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,722.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,722.56
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	$5,722.56
Rate for Payer: Cigna Commercial	$11,220.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,732.42
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$540.84
Rate for Payer: Wellpoint Medicaid Managed Care	$594.70

IR REVSC OPN/PRQ TIB/PERO STEN

Facility

$22,441.40

Service Code	HCPCS 37234
Hospital Charge Code	7411524
Hospital Revenue Code	361
Min. Negotiated Rate	$3,366.21
Max. Negotiated Rate	$3,366.21
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21

IR REVSC OPN/PRQ TIB/PERO STEN

Facility

$22,441.40

Service Code	HCPCS 37234
Hospital Charge Code	321037234
Hospital Revenue Code	361
Min. Negotiated Rate	$3,366.21
Max. Negotiated Rate	$3,366.21
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21

IR-RFA KIDNEY-BI

Facility

$26,912.85

Service Code	HCPCS 5059250
Hospital Charge Code	2690665
Hospital Revenue Code	361
Min. Negotiated Rate	$4,036.93
Max. Negotiated Rate	$4,036.93
Rate for Payer: Qualcare PPO/HMO/WC	$4,036.93

IR-RFA KIDNEY-BI

Facility

$15,231.00

Service Code	HCPCS 5059250
Hospital Charge Code	7411826
Hospital Revenue Code	361
Min. Negotiated Rate	$367.07
Max. Negotiated Rate	$7,615.50
Rate for Payer: Aetna Commercial	$5,787.78
Rate for Payer: Aetna Medicare Advantage	$4,569.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,883.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,883.91
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	$3,883.91
Rate for Payer: Cigna Commercial	$7,615.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,569.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,284.65
Rate for Payer: UnitedHealthcare Community & State	$367.07
Rate for Payer: Wellpoint Medicaid Managed Care	$403.62

IR-RFA KIDNEY-BI

Facility

$15,231.00

Service Code	HCPCS 5059250
Hospital Charge Code	7411826
Hospital Revenue Code	361
Min. Negotiated Rate	$2,284.65
Max. Negotiated Rate	$2,284.65
Rate for Payer: Qualcare PPO/HMO/WC	$2,284.65

IR-RFA KIDNEY-BI

Facility

$26,912.85

Service Code	HCPCS 5059250
Hospital Charge Code	2690665
Hospital Revenue Code	361
Min. Negotiated Rate	$648.60
Max. Negotiated Rate	$13,456.42
Rate for Payer: Aetna Commercial	$10,226.88
Rate for Payer: Aetna Medicare Advantage	$8,073.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,862.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,862.78
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	$6,862.78
Rate for Payer: Cigna Commercial	$13,456.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,073.85
Rate for Payer: Qualcare PPO/HMO/WC	$4,036.93
Rate for Payer: UnitedHealthcare Community & State	$648.60
Rate for Payer: Wellpoint Medicaid Managed Care	$713.19

IR-RFA KIDNEY-BI

Facility

$26,912.85

Service Code	HCPCS 5059250
Hospital Charge Code	321050592B
Hospital Revenue Code	361
Min. Negotiated Rate	$648.60
Max. Negotiated Rate	$13,456.42
Rate for Payer: Aetna Commercial	$10,226.88
Rate for Payer: Aetna Medicare Advantage	$8,073.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,862.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,862.78
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	$6,862.78
Rate for Payer: Cigna Commercial	$13,456.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,073.85
Rate for Payer: Qualcare PPO/HMO/WC	$4,036.93
Rate for Payer: UnitedHealthcare Community & State	$648.60
Rate for Payer: Wellpoint Medicaid Managed Care	$713.19

IR-RFA KIDNEY-BI

Facility

$26,912.85

Service Code	HCPCS 5059250
Hospital Charge Code	321050592B
Hospital Revenue Code	361
Min. Negotiated Rate	$4,036.93
Max. Negotiated Rate	$4,036.93
Rate for Payer: Qualcare PPO/HMO/WC	$4,036.93

IR-RFA KIDNEY-LT

Facility

$15,231.00

Service Code	HCPCS 50592LT
Hospital Charge Code	7411972
Hospital Revenue Code	361
Min. Negotiated Rate	$2,284.65
Max. Negotiated Rate	$2,284.65
Rate for Payer: Qualcare PPO/HMO/WC	$2,284.65

IR-RFA KIDNEY-LT

Facility

$15,231.00

Service Code	HCPCS 50592LT
Hospital Charge Code	2691660
Hospital Revenue Code	361
Min. Negotiated Rate	$2,284.65
Max. Negotiated Rate	$2,284.65
Rate for Payer: Qualcare PPO/HMO/WC	$2,284.65

IR-RFA KIDNEY-LT

Facility

$15,231.00

Service Code	HCPCS 50592LT
Hospital Charge Code	7411972
Hospital Revenue Code	361
Min. Negotiated Rate	$367.07
Max. Negotiated Rate	$7,615.50
Rate for Payer: Aetna Commercial	$5,787.78
Rate for Payer: Aetna Medicare Advantage	$4,569.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,883.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,883.91
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	$3,883.91
Rate for Payer: Cigna Commercial	$7,615.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,569.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,284.65
Rate for Payer: UnitedHealthcare Community & State	$367.07
Rate for Payer: Wellpoint Medicaid Managed Care	$403.62

IR-RFA KIDNEY-LT

Facility

$15,231.00

Service Code	HCPCS 50592LT
Hospital Charge Code	2691660
Hospital Revenue Code	361
Min. Negotiated Rate	$367.07
Max. Negotiated Rate	$7,615.50
Rate for Payer: Aetna Commercial	$5,787.78
Rate for Payer: Aetna Medicare Advantage	$4,569.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,883.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,883.91
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	$3,883.91
Rate for Payer: Cigna Commercial	$7,615.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,569.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,284.65
Rate for Payer: UnitedHealthcare Community & State	$367.07
Rate for Payer: Wellpoint Medicaid Managed Care	$403.62

IR-RFA KIDNEY-RT

Facility

$15,231.00

Service Code	HCPCS 50592RT
Hospital Charge Code	7411973
Hospital Revenue Code	361
Min. Negotiated Rate	$2,284.65
Max. Negotiated Rate	$2,284.65
Rate for Payer: Qualcare PPO/HMO/WC	$2,284.65

IR-RFA KIDNEY-RT

Facility

$15,231.00

Service Code	HCPCS 50592RT
Hospital Charge Code	2691665
Hospital Revenue Code	361
Min. Negotiated Rate	$2,284.65
Max. Negotiated Rate	$2,284.65
Rate for Payer: Qualcare PPO/HMO/WC	$2,284.65

IR-RFA KIDNEY-RT

Facility

$15,231.00

Service Code	HCPCS 50592RT
Hospital Charge Code	7411973
Hospital Revenue Code	361
Min. Negotiated Rate	$367.07
Max. Negotiated Rate	$7,615.50
Rate for Payer: Aetna Commercial	$5,787.78
Rate for Payer: Aetna Medicare Advantage	$4,569.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,883.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,883.91
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	$3,883.91
Rate for Payer: Cigna Commercial	$7,615.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,569.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,284.65
Rate for Payer: UnitedHealthcare Community & State	$367.07
Rate for Payer: Wellpoint Medicaid Managed Care	$403.62

IR-RFA KIDNEY-RT

Facility

$15,231.00

Service Code	HCPCS 50592RT
Hospital Charge Code	2691665
Hospital Revenue Code	361
Min. Negotiated Rate	$367.07
Max. Negotiated Rate	$7,615.50
Rate for Payer: Aetna Commercial	$5,787.78
Rate for Payer: Aetna Medicare Advantage	$4,569.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,883.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,883.91
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	$3,883.91
Rate for Payer: Cigna Commercial	$7,615.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,569.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,284.65
Rate for Payer: UnitedHealthcare Community & State	$367.07
Rate for Payer: Wellpoint Medicaid Managed Care	$403.62

IR-RFA LUNG-BIL

Facility

$15,231.00

Service Code	HCPCS 3299850
Hospital Charge Code	7411785
Hospital Revenue Code	361
Min. Negotiated Rate	$367.07
Max. Negotiated Rate	$7,615.50
Rate for Payer: Aetna Commercial	$5,787.78
Rate for Payer: Aetna Medicare Advantage	$4,569.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,883.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,883.91
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	$3,883.91
Rate for Payer: Cigna Commercial	$7,615.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,569.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,284.65
Rate for Payer: UnitedHealthcare Community & State	$367.07
Rate for Payer: Wellpoint Medicaid Managed Care	$403.62

IR-RFA LUNG-BIL

Facility

$15,231.00

Service Code	HCPCS 3299850
Hospital Charge Code	7411785
Hospital Revenue Code	361
Min. Negotiated Rate	$2,284.65
Max. Negotiated Rate	$2,284.65
Rate for Payer: Qualcare PPO/HMO/WC	$2,284.65

IR-RFA LUNG-BIL

Facility

$15,231.00

Service Code	HCPCS 3299850
Hospital Charge Code	2690400
Hospital Revenue Code	361
Min. Negotiated Rate	$367.07
Max. Negotiated Rate	$7,615.50
Rate for Payer: Aetna Commercial	$5,787.78
Rate for Payer: Aetna Medicare Advantage	$4,569.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,883.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,883.91
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	$3,883.91
Rate for Payer: Cigna Commercial	$7,615.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,569.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,284.65
Rate for Payer: UnitedHealthcare Community & State	$367.07
Rate for Payer: Wellpoint Medicaid Managed Care	$403.62

Know your out-of-pocket cost for care.

All Charges