Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DILATE BILIARY DUCT/AMPULLA

Facility

$8,460.00

Service Code	HCPCS 47543
Hospital Charge Code	404647543
Hospital Revenue Code	361
Min. Negotiated Rate	$1,269.00
Max. Negotiated Rate	$1,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,269.00

DILATE BILIARY DUCT/AMPULLA

Facility

$8,460.00

Service Code	HCPCS 47543
Hospital Charge Code	404647543
Hospital Revenue Code	361
Min. Negotiated Rate	$203.89
Max. Negotiated Rate	$4,230.00
Rate for Payer: Aetna Commercial	$3,214.80
Rate for Payer: Aetna Medicare Advantage	$2,538.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,157.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,157.30
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	$2,157.30
Rate for Payer: Cigna Commercial	$4,230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,538.00
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,269.00
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$203.89
Rate for Payer: Wellpoint Medicaid Managed Care	$224.19

DILATE IC VASOSPASM INIT

Facility

$61,616.39

Service Code	HCPCS 61640
Hospital Charge Code	411061640
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

DILATE IC VASOSPASM INIT

Facility

$61,616.39

Service Code	HCPCS 61640
Hospital Charge Code	411061640
Hospital Revenue Code	361
Min. Negotiated Rate	$1,484.95
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,484.92
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$1,484.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1,632.83

DILATE IC VSPSM EA DIFF TERR

Facility

$61,616.39

Service Code	HCPCS 61642
Hospital Charge Code	411061642
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

DILATE IC VSPSM EA DIFF TERR

Facility

$61,616.39

Service Code	HCPCS 61642
Hospital Charge Code	411061642
Hospital Revenue Code	361
Min. Negotiated Rate	$1,484.95
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,484.92
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$1,484.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1,632.83

DILATE IC VSPSM EA VSL SM TER

Facility

$61,616.39

Service Code	HCPCS 61641
Hospital Charge Code	411061641
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

DILATE IC VSPSM EA VSL SM TER

Facility

$61,616.39

Service Code	HCPCS 61641
Hospital Charge Code	411061641
Hospital Revenue Code	361
Min. Negotiated Rate	$1,484.95
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,484.92
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$1,484.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1,632.83

DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES

Facility

$8,755.70

Service Code	APR-DRG 5171
Min. Negotiated Rate	$8,584.02
Max. Negotiated Rate	$8,755.70
Rate for Payer: UnitedHealthcare Community & State	$8,584.02
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,755.70
Rate for Payer: Wellpoint Medicaid Managed Care	$8,584.02

DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES

Facility

$17,456.48

Service Code	APR-DRG 5173
Min. Negotiated Rate	$17,114.20
Max. Negotiated Rate	$17,456.48
Rate for Payer: UnitedHealthcare Community & State	$17,114.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$17,456.48
Rate for Payer: Wellpoint Medicaid Managed Care	$17,114.20

DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES

Facility

$30,841.47

Service Code	APR-DRG 5174
Min. Negotiated Rate	$30,236.74
Max. Negotiated Rate	$30,841.47
Rate for Payer: UnitedHealthcare Community & State	$30,236.74
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$30,841.47
Rate for Payer: Wellpoint Medicaid Managed Care	$30,236.74

DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES

Facility

$10,825.23

Service Code	APR-DRG 5172
Min. Negotiated Rate	$10,612.97
Max. Negotiated Rate	$10,825.23
Rate for Payer: UnitedHealthcare Community & State	$10,612.97
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,825.23
Rate for Payer: Wellpoint Medicaid Managed Care	$10,612.97

DILATIONS SYS ENTERAL ACCES 24

Facility

$493.75

Hospital Charge Code	270683432
Hospital Revenue Code	272
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$246.88
Rate for Payer: Aetna Commercial	$187.62
Rate for Payer: Aetna Medicare Advantage	$148.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$125.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$125.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$125.91
Rate for Payer: Cigna Commercial	$246.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$148.12
Rate for Payer: Oxford Commercial	$98.75
Rate for Payer: Qualcare PPO/HMO/WC	$74.06
Rate for Payer: UnitedHealthcare Commercial	$98.75
Rate for Payer: UnitedHealthcare Community & State	$11.90
Rate for Payer: Wellpoint Medicaid Managed Care	$13.08

DILATIONS SYS ENTERAL ACCES 24

Facility

$493.75

Hospital Charge Code	270683432
Hospital Revenue Code	272
Min. Negotiated Rate	$74.06
Max. Negotiated Rate	$74.06
Rate for Payer: Qualcare PPO/HMO/WC	$74.06

DILATION SYSTEM ENTERAL ACCESS

Facility

$493.75

Hospital Charge Code	270672030N
Hospital Revenue Code	272
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$246.88
Rate for Payer: Aetna Commercial	$187.62
Rate for Payer: Aetna Medicare Advantage	$148.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$125.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$125.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$125.91
Rate for Payer: Cigna Commercial	$246.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$148.12
Rate for Payer: Oxford Commercial	$98.75
Rate for Payer: Qualcare PPO/HMO/WC	$74.06
Rate for Payer: UnitedHealthcare Commercial	$98.75
Rate for Payer: UnitedHealthcare Community & State	$11.90
Rate for Payer: Wellpoint Medicaid Managed Care	$13.08

DILATION SYSTEM ENTERAL ACCESS

Facility

$493.75

Hospital Charge Code	270672030N
Hospital Revenue Code	272
Min. Negotiated Rate	$74.06
Max. Negotiated Rate	$74.06
Rate for Payer: Qualcare PPO/HMO/WC	$74.06

DILATION SYSTEM ENTERAL ACCESS

Facility

$501.25

Hospital Charge Code	270672030
Hospital Revenue Code	272
Min. Negotiated Rate	$12.08
Max. Negotiated Rate	$250.62
Rate for Payer: Aetna Commercial	$190.47
Rate for Payer: Aetna Medicare Advantage	$150.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.82
Rate for Payer: Cigna Commercial	$250.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.38
Rate for Payer: Oxford Commercial	$100.25
Rate for Payer: Qualcare PPO/HMO/WC	$75.19
Rate for Payer: UnitedHealthcare Commercial	$100.25
Rate for Payer: UnitedHealthcare Community & State	$12.08
Rate for Payer: Wellpoint Medicaid Managed Care	$13.28

DILATION SYSTEM ENTERAL ACCESS

Facility

$501.25

Hospital Charge Code	270672030
Hospital Revenue Code	272
Min. Negotiated Rate	$75.19
Max. Negotiated Rate	$75.19
Rate for Payer: Qualcare PPO/HMO/WC	$75.19

DILATOR 4FR .035

Facility

$27.61

Hospital Charge Code	270630843
Hospital Revenue Code	272
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$4.14
Rate for Payer: Qualcare PPO/HMO/WC	$4.14

DILATOR 4FR .035

Facility

$27.61

Hospital Charge Code	270630843
Hospital Revenue Code	272
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$13.80
Rate for Payer: Aetna Commercial	$10.49
Rate for Payer: Aetna Medicare Advantage	$8.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.04
Rate for Payer: Cigna Commercial	$13.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.28
Rate for Payer: Oxford Commercial	$5.52
Rate for Payer: Qualcare PPO/HMO/WC	$4.14
Rate for Payer: UnitedHealthcare Commercial	$5.52
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.73

DILATOR 4FR .035 48-149

Facility

$27.61

Hospital Charge Code	270630843C
Hospital Revenue Code	272
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$4.14
Rate for Payer: Qualcare PPO/HMO/WC	$4.14

DILATOR 4FR .035 48-149

Facility

$27.61

Hospital Charge Code	270630843C
Hospital Revenue Code	272
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$13.80
Rate for Payer: Aetna Commercial	$10.49
Rate for Payer: Aetna Medicare Advantage	$8.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.04
Rate for Payer: Cigna Commercial	$13.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.28
Rate for Payer: Oxford Commercial	$5.52
Rate for Payer: Qualcare PPO/HMO/WC	$4.14
Rate for Payer: UnitedHealthcare Commercial	$5.52
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.73

DILATOR 5FR

Facility

$27.61

Hospital Charge Code	270651985
Hospital Revenue Code	272
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$13.80
Rate for Payer: Aetna Commercial	$10.49
Rate for Payer: Aetna Medicare Advantage	$8.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.04
Rate for Payer: Cigna Commercial	$13.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.28
Rate for Payer: Oxford Commercial	$5.52
Rate for Payer: Qualcare PPO/HMO/WC	$4.14
Rate for Payer: UnitedHealthcare Commercial	$5.52
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.73

DILATOR 5FR

Facility

$27.61

Hospital Charge Code	270651985
Hospital Revenue Code	272
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$4.14
Rate for Payer: Qualcare PPO/HMO/WC	$4.14

DILATOR 7FR

Facility

$22.52

Hospital Charge Code	270651988
Hospital Revenue Code	270
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$3.38

Know your out-of-pocket cost for care.

All Charges