Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLMT URETERL STNT EXISTING

Facility

$13,482.90

Service Code	HCPCS 50693
Hospital Charge Code	366850693
Hospital Revenue Code	361
Min. Negotiated Rate	$2,022.43
Max. Negotiated Rate	$2,022.43
Rate for Payer: Qualcare PPO/HMO/WC	$2,022.43

PLMT URETERL STNT EXISTING

Facility

$13,482.90

Service Code	HCPCS 50693
Hospital Charge Code	411050693
Hospital Revenue Code	361
Min. Negotiated Rate	$2,022.43
Max. Negotiated Rate	$2,022.43
Rate for Payer: Qualcare PPO/HMO/WC	$2,022.43

PLMT URETERL STNT EXISTING

Facility

$13,218.42

Service Code	HCPCS 50693
Hospital Charge Code	2600228
Hospital Revenue Code	361
Min. Negotiated Rate	$1,982.76
Max. Negotiated Rate	$1,982.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76

PLMT URETERL STNT EXISTING

Facility

$13,482.90

Service Code	HCPCS 50693
Hospital Charge Code	366850693
Hospital Revenue Code	361
Min. Negotiated Rate	$324.94
Max. Negotiated Rate	$15,116.59
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
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	$15,116.59
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,044.87
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,022.43
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$324.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$357.30

PLMT URETERL STNT EXISTING BI

Facility

$13,218.42

Service Code	HCPCS 5069350
Hospital Charge Code	2011576
Hospital Revenue Code	361
Min. Negotiated Rate	$1,982.76
Max. Negotiated Rate	$1,982.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76

PLMT URETERL STNT EXISTING BI

Facility

$13,218.42

Service Code	HCPCS 5069350
Hospital Charge Code	2011576
Hospital Revenue Code	361
Min. Negotiated Rate	$318.56
Max. Negotiated Rate	$6,609.21
Rate for Payer: Aetna Commercial	$5,023.00
Rate for Payer: Aetna Medicare Advantage	$3,965.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,370.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,370.70
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	$3,370.70
Rate for Payer: Cigna Commercial	$6,609.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,965.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76
Rate for Payer: UnitedHealthcare Community & State	$318.56
Rate for Payer: Wellpoint Medicaid Managed Care	$350.29

PLMT URETERL STNT EXISTING LT

Facility

$13,218.42

Service Code	HCPCS 50693LT
Hospital Charge Code	2011591
Hospital Revenue Code	361
Min. Negotiated Rate	$1,982.76
Max. Negotiated Rate	$1,982.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76

PLMT URETERL STNT EXISTING LT

Facility

$13,218.42

Service Code	HCPCS 50693LT
Hospital Charge Code	2011591
Hospital Revenue Code	361
Min. Negotiated Rate	$318.56
Max. Negotiated Rate	$6,609.21
Rate for Payer: Aetna Commercial	$5,023.00
Rate for Payer: Aetna Medicare Advantage	$3,965.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,370.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,370.70
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	$3,370.70
Rate for Payer: Cigna Commercial	$6,609.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,965.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76
Rate for Payer: UnitedHealthcare Community & State	$318.56
Rate for Payer: Wellpoint Medicaid Managed Care	$350.29

PLMT URETERL STNT EXISTING RT

Facility

$13,218.42

Service Code	HCPCS 50693RT
Hospital Charge Code	2011584
Hospital Revenue Code	361
Min. Negotiated Rate	$318.56
Max. Negotiated Rate	$6,609.21
Rate for Payer: Aetna Commercial	$5,023.00
Rate for Payer: Aetna Medicare Advantage	$3,965.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,370.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,370.70
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	$3,370.70
Rate for Payer: Cigna Commercial	$6,609.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,965.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76
Rate for Payer: UnitedHealthcare Community & State	$318.56
Rate for Payer: Wellpoint Medicaid Managed Care	$350.29

PLMT URETERL STNT EXISTING RT

Facility

$13,218.42

Service Code	HCPCS 50693RT
Hospital Charge Code	2011584
Hospital Revenue Code	361
Min. Negotiated Rate	$1,982.76
Max. Negotiated Rate	$1,982.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76

PLMT URETRL STNT NEW W CTH

Facility

$17,139.40

Service Code	HCPCS 50695
Hospital Charge Code	2600230
Hospital Revenue Code	361
Min. Negotiated Rate	$413.06
Max. Negotiated Rate	$15,116.59
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
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	$15,116.59
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,141.82
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,570.91
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$413.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$454.19

PLMT URETRL STNT NEW W CTH

Facility

$17,139.40

Service Code	HCPCS 50695
Hospital Charge Code	2600230
Hospital Revenue Code	361
Min. Negotiated Rate	$2,570.91
Max. Negotiated Rate	$2,570.91
Rate for Payer: Qualcare PPO/HMO/WC	$2,570.91

PLMT URETRL STNT NEW W CTH

Facility

$13,218.42

Service Code	HCPCS 50695
Hospital Charge Code	7411619
Hospital Revenue Code	361
Min. Negotiated Rate	$1,982.76
Max. Negotiated Rate	$1,982.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76

PLMT URETRL STNT NEW W CTH

Facility

$13,218.42

Service Code	HCPCS 50695
Hospital Charge Code	7411619
Hospital Revenue Code	361
Min. Negotiated Rate	$318.56
Max. Negotiated Rate	$15,116.59
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
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	$15,116.59
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,965.53
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$318.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$350.29

PLMT URETRL STNT NEW W CTH BI

Facility

$13,218.42

Service Code	HCPCS 5069550
Hospital Charge Code	2011578
Hospital Revenue Code	361
Min. Negotiated Rate	$318.56
Max. Negotiated Rate	$6,609.21
Rate for Payer: Aetna Commercial	$5,023.00
Rate for Payer: Aetna Medicare Advantage	$3,965.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,370.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,370.70
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	$3,370.70
Rate for Payer: Cigna Commercial	$6,609.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,965.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76
Rate for Payer: UnitedHealthcare Community & State	$318.56
Rate for Payer: Wellpoint Medicaid Managed Care	$350.29

PLMT URETRL STNT NEW W CTH BI

Facility

$13,218.42

Service Code	HCPCS 5069550
Hospital Charge Code	2011578
Hospital Revenue Code	361
Min. Negotiated Rate	$1,982.76
Max. Negotiated Rate	$1,982.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76

PLMT URETRL STNT NEW W CTH LT

Facility

$13,218.42

Service Code	HCPCS 50695LT
Hospital Charge Code	2011593
Hospital Revenue Code	361
Min. Negotiated Rate	$318.56
Max. Negotiated Rate	$6,609.21
Rate for Payer: Aetna Commercial	$5,023.00
Rate for Payer: Aetna Medicare Advantage	$3,965.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,370.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,370.70
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	$3,370.70
Rate for Payer: Cigna Commercial	$6,609.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,965.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76
Rate for Payer: UnitedHealthcare Community & State	$318.56
Rate for Payer: Wellpoint Medicaid Managed Care	$350.29

PLMT URETRL STNT NEW W CTH LT

Facility

$13,218.42

Service Code	HCPCS 50695LT
Hospital Charge Code	2011593
Hospital Revenue Code	361
Min. Negotiated Rate	$1,982.76
Max. Negotiated Rate	$1,982.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76

PLMT URETRL STNT NEW W CTH RT

Facility

$13,218.42

Service Code	HCPCS 50695RT
Hospital Charge Code	2011586
Hospital Revenue Code	361
Min. Negotiated Rate	$318.56
Max. Negotiated Rate	$6,609.21
Rate for Payer: Aetna Commercial	$5,023.00
Rate for Payer: Aetna Medicare Advantage	$3,965.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,370.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,370.70
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	$3,370.70
Rate for Payer: Cigna Commercial	$6,609.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,965.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76
Rate for Payer: UnitedHealthcare Community & State	$318.56
Rate for Payer: Wellpoint Medicaid Managed Care	$350.29

PLMT URETRL STNT NEW W CTH RT

Facility

$13,218.42

Service Code	HCPCS 50695RT
Hospital Charge Code	2011586
Hospital Revenue Code	361
Min. Negotiated Rate	$1,982.76
Max. Negotiated Rate	$1,982.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76

PLMT URETRL STNT NEW WO CTH

Facility

$13,218.42

Service Code	HCPCS 50694
Hospital Charge Code	2600229
Hospital Revenue Code	361
Min. Negotiated Rate	$1,982.76
Max. Negotiated Rate	$1,982.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76

PLMT URETRL STNT NEW WO CTH

Facility

$13,218.42

Service Code	HCPCS 50694
Hospital Charge Code	7411618
Hospital Revenue Code	361
Min. Negotiated Rate	$318.56
Max. Negotiated Rate	$15,116.59
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
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	$15,116.59
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,965.53
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$318.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$350.29

PLMT URETRL STNT NEW WO CTH

Facility

$13,218.42

Service Code	HCPCS 50694
Hospital Charge Code	7411618
Hospital Revenue Code	361
Min. Negotiated Rate	$1,982.76
Max. Negotiated Rate	$1,982.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76

PLMT URETRL STNT NEW WO CTH

Facility

$13,218.42

Service Code	HCPCS 50694
Hospital Charge Code	2600229
Hospital Revenue Code	361
Min. Negotiated Rate	$318.56
Max. Negotiated Rate	$15,116.59
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
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	$15,116.59
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,965.53
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$318.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$350.29

PLMT URETRL STNT NEW WO CTH BI

Facility

$13,218.42

Service Code	HCPCS 5069450
Hospital Charge Code	2011577
Hospital Revenue Code	361
Min. Negotiated Rate	$318.56
Max. Negotiated Rate	$6,609.21
Rate for Payer: Aetna Commercial	$5,023.00
Rate for Payer: Aetna Medicare Advantage	$3,965.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,370.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,370.70
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	$3,370.70
Rate for Payer: Cigna Commercial	$6,609.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,965.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76
Rate for Payer: UnitedHealthcare Community & State	$318.56
Rate for Payer: Wellpoint Medicaid Managed Care	$350.29

Know your out-of-pocket cost for care.

All Charges