Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DILATOR ESOPHAGEAL 8-9-10

Facility

$1,067.35

Hospital Charge Code	270666753
Hospital Revenue Code	272
Min. Negotiated Rate	$160.10
Max. Negotiated Rate	$160.10
Rate for Payer: Qualcare PPO/HMO/WC	$160.10

DILATOR ESOPHAGEAL 8-9-10

Facility

$1,067.35

Hospital Charge Code	270666753
Hospital Revenue Code	272
Min. Negotiated Rate	$25.72
Max. Negotiated Rate	$533.67
Rate for Payer: Aetna Commercial	$405.59
Rate for Payer: Aetna Medicare Advantage	$320.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.17
Rate for Payer: Cigna Commercial	$533.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.20
Rate for Payer: Oxford Commercial	$213.47
Rate for Payer: Qualcare PPO/HMO/WC	$160.10
Rate for Payer: UnitedHealthcare Commercial	$213.47
Rate for Payer: UnitedHealthcare Community & State	$25.72
Rate for Payer: Wellpoint Medicaid Managed Care	$28.28

DILATOR HEAGAR SINGLE 15 MM

Facility

$167.85

Hospital Charge Code	270689048
Hospital Revenue Code	272
Min. Negotiated Rate	$25.18
Max. Negotiated Rate	$25.18
Rate for Payer: Qualcare PPO/HMO/WC	$25.18

DILATOR HEAGAR SINGLE 15 MM

Facility

$167.85

Hospital Charge Code	270689048
Hospital Revenue Code	272
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$83.92
Rate for Payer: Aetna Commercial	$63.78
Rate for Payer: Aetna Medicare Advantage	$50.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.80
Rate for Payer: Cigna Commercial	$83.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.35
Rate for Payer: Oxford Commercial	$33.57
Rate for Payer: Qualcare PPO/HMO/WC	$25.18
Rate for Payer: UnitedHealthcare Commercial	$33.57
Rate for Payer: UnitedHealthcare Community & State	$4.05
Rate for Payer: Wellpoint Medicaid Managed Care	$4.45

DILATOR HEAGAR SINGLE 4 MM

Facility

$70.35

Hospital Charge Code	270689047
Hospital Revenue Code	272
Min. Negotiated Rate	$10.55
Max. Negotiated Rate	$10.55
Rate for Payer: Qualcare PPO/HMO/WC	$10.55

DILATOR HEAGAR SINGLE 4 MM

Facility

$70.35

Hospital Charge Code	270689047
Hospital Revenue Code	272
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$35.17
Rate for Payer: Aetna Commercial	$26.73
Rate for Payer: Aetna Medicare Advantage	$21.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.94
Rate for Payer: Cigna Commercial	$35.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.11
Rate for Payer: Oxford Commercial	$14.07
Rate for Payer: Qualcare PPO/HMO/WC	$10.55
Rate for Payer: UnitedHealthcare Commercial	$14.07
Rate for Payer: UnitedHealthcare Community & State	$1.70
Rate for Payer: Wellpoint Medicaid Managed Care	$1.86

DILATOR HEAGER SINGEL ENDED 18

Facility

$219.15

Hospital Charge Code	270689050
Hospital Revenue Code	272
Min. Negotiated Rate	$32.87
Max. Negotiated Rate	$32.87
Rate for Payer: Qualcare PPO/HMO/WC	$32.87

DILATOR HEAGER SINGEL ENDED 18

Facility

$219.15

Hospital Charge Code	270689050
Hospital Revenue Code	272
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$109.58
Rate for Payer: Aetna Commercial	$83.28
Rate for Payer: Aetna Medicare Advantage	$65.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.88
Rate for Payer: Cigna Commercial	$109.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.75
Rate for Payer: Oxford Commercial	$43.83
Rate for Payer: Qualcare PPO/HMO/WC	$32.87
Rate for Payer: UnitedHealthcare Commercial	$43.83
Rate for Payer: UnitedHealthcare Community & State	$5.28
Rate for Payer: Wellpoint Medicaid Managed Care	$5.81

DILATOR HEAGER SINGLE 16 MM

Facility

$209.15

Hospital Charge Code	270689049
Hospital Revenue Code	272
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$104.58
Rate for Payer: Aetna Commercial	$79.48
Rate for Payer: Aetna Medicare Advantage	$62.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.33
Rate for Payer: Cigna Commercial	$104.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.74
Rate for Payer: Oxford Commercial	$41.83
Rate for Payer: Qualcare PPO/HMO/WC	$31.37
Rate for Payer: UnitedHealthcare Commercial	$41.83
Rate for Payer: UnitedHealthcare Community & State	$5.04
Rate for Payer: Wellpoint Medicaid Managed Care	$5.54

DILATOR HEAGER SINGLE 16 MM

Facility

$209.15

Hospital Charge Code	270689049
Hospital Revenue Code	272
Min. Negotiated Rate	$31.37
Max. Negotiated Rate	$31.37
Rate for Payer: Qualcare PPO/HMO/WC	$31.37

DILATOR INSULATD PHANTOM 8-18

Facility

$6,727.50

Hospital Charge Code	270693706
Hospital Revenue Code	272
Min. Negotiated Rate	$162.13
Max. Negotiated Rate	$3,363.75
Rate for Payer: Aetna Commercial	$2,556.45
Rate for Payer: Aetna Medicare Advantage	$2,018.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,715.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,715.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,715.51
Rate for Payer: Cigna Commercial	$3,363.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,018.25
Rate for Payer: Oxford Commercial	$1,345.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,009.12
Rate for Payer: UnitedHealthcare Commercial	$1,345.50
Rate for Payer: UnitedHealthcare Community & State	$162.13
Rate for Payer: Wellpoint Medicaid Managed Care	$178.28

DILATOR INSULATD PHANTOM 8-18

Facility

$6,727.50

Hospital Charge Code	270693706
Hospital Revenue Code	272
Min. Negotiated Rate	$1,009.12
Max. Negotiated Rate	$1,009.12
Rate for Payer: Qualcare PPO/HMO/WC	$1,009.12

DILATOR MCV BALLN 5.8F 14-514

Facility

$1,530.45

Hospital Charge Code	270624069V
Hospital Revenue Code	278
Min. Negotiated Rate	$36.88
Max. Negotiated Rate	$765.23
Rate for Payer: Aetna Commercial	$581.57
Rate for Payer: Aetna Medicare Advantage	$459.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$390.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$390.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$306.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$390.26
Rate for Payer: Cigna Commercial	$765.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$370.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$336.70
Rate for Payer: Qualcare PPO/HMO/WC	$229.57
Rate for Payer: UnitedHealthcare Community & State	$36.88
Rate for Payer: Wellpoint Medicaid Managed Care	$40.56

DILATOR MCV BALLN 5.8F 14-514

Facility

$1,530.45

Hospital Charge Code	270624069V
Hospital Revenue Code	278
Min. Negotiated Rate	$229.57
Max. Negotiated Rate	$370.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$306.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$370.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$336.70
Rate for Payer: Qualcare PPO/HMO/WC	$229.57

DILATOR MCV COL BALLN 15F 5514

Facility

$2,455.25

Hospital Charge Code	270600943
Hospital Revenue Code	278
Min. Negotiated Rate	$368.29
Max. Negotiated Rate	$594.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$491.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$594.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$540.15
Rate for Payer: Qualcare PPO/HMO/WC	$368.29

DILATOR MCV COL BALLN 15F 5514

Facility

$2,455.25

Hospital Charge Code	270600943
Hospital Revenue Code	278
Min. Negotiated Rate	$59.17
Max. Negotiated Rate	$1,227.62
Rate for Payer: Aetna Commercial	$933.00
Rate for Payer: Aetna Medicare Advantage	$736.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$626.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$626.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$491.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$626.09
Rate for Payer: Cigna Commercial	$1,227.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$594.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$540.15
Rate for Payer: Qualcare PPO/HMO/WC	$368.29
Rate for Payer: UnitedHealthcare Community & State	$59.17
Rate for Payer: Wellpoint Medicaid Managed Care	$65.06

DILATOR MCV RIGIFLEX 14F 5311

Facility

$4,596.85

Hospital Charge Code	270600942
Hospital Revenue Code	272
Min. Negotiated Rate	$110.78
Max. Negotiated Rate	$2,298.43
Rate for Payer: Aetna Commercial	$1,746.80
Rate for Payer: Aetna Medicare Advantage	$1,379.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,172.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,172.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,172.20
Rate for Payer: Cigna Commercial	$2,298.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,379.06
Rate for Payer: Oxford Commercial	$919.37
Rate for Payer: Qualcare PPO/HMO/WC	$689.53
Rate for Payer: UnitedHealthcare Commercial	$919.37
Rate for Payer: UnitedHealthcare Community & State	$110.78
Rate for Payer: Wellpoint Medicaid Managed Care	$121.82

DILATOR MCV RIGIFLEX 14F 5311

Facility

$4,596.85

Hospital Charge Code	270600942
Hospital Revenue Code	272
Min. Negotiated Rate	$689.53
Max. Negotiated Rate	$689.53
Rate for Payer: Qualcare PPO/HMO/WC	$689.53

DILATOR RX BILIARY 10mx4c 4596

Facility

$1,215.05

Service Code	HCPCS C1876
Hospital Charge Code	270630342
Hospital Revenue Code	278
Min. Negotiated Rate	$29.28
Max. Negotiated Rate	$607.52
Rate for Payer: Aetna Commercial	$461.72
Rate for Payer: Aetna Medicare Advantage	$364.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.84
Rate for Payer: Cigna Commercial	$607.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$267.31
Rate for Payer: Qualcare PPO/HMO/WC	$182.26
Rate for Payer: UnitedHealthcare Community & State	$29.28
Rate for Payer: Wellpoint Medicaid Managed Care	$32.20

DILATOR RX BILIARY 10mx4c 4596

Facility

$1,215.05

Service Code	HCPCS C1876
Hospital Charge Code	270630342
Hospital Revenue Code	278
Min. Negotiated Rate	$182.26
Max. Negotiated Rate	$294.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$267.31
Rate for Payer: Qualcare PPO/HMO/WC	$182.26

DILATOR RX BILIARY 4mx4c 4590

Facility

$1,215.05

Service Code	HCPCS C1876
Hospital Charge Code	270630339
Hospital Revenue Code	278
Min. Negotiated Rate	$182.26
Max. Negotiated Rate	$294.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$267.31
Rate for Payer: Qualcare PPO/HMO/WC	$182.26

DILATOR RX BILIARY 4mx4c 4590

Facility

$1,215.05

Service Code	HCPCS C1876
Hospital Charge Code	270630339
Hospital Revenue Code	278
Min. Negotiated Rate	$29.28
Max. Negotiated Rate	$607.52
Rate for Payer: Aetna Commercial	$461.72
Rate for Payer: Aetna Medicare Advantage	$364.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.84
Rate for Payer: Cigna Commercial	$607.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$267.31
Rate for Payer: Qualcare PPO/HMO/WC	$182.26
Rate for Payer: UnitedHealthcare Community & State	$29.28
Rate for Payer: Wellpoint Medicaid Managed Care	$32.20

DILATOR RX BILIARY 6mx4c 4592

Facility

$1,215.05

Service Code	HCPCS C1876
Hospital Charge Code	270630340
Hospital Revenue Code	278
Min. Negotiated Rate	$29.28
Max. Negotiated Rate	$607.52
Rate for Payer: Aetna Commercial	$461.72
Rate for Payer: Aetna Medicare Advantage	$364.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.84
Rate for Payer: Cigna Commercial	$607.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$267.31
Rate for Payer: Qualcare PPO/HMO/WC	$182.26
Rate for Payer: UnitedHealthcare Community & State	$29.28
Rate for Payer: Wellpoint Medicaid Managed Care	$32.20

DILATOR RX BILIARY 6mx4c 4592

Facility

$1,215.05

Service Code	HCPCS C1876
Hospital Charge Code	270630340
Hospital Revenue Code	278
Min. Negotiated Rate	$182.26
Max. Negotiated Rate	$294.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$267.31
Rate for Payer: Qualcare PPO/HMO/WC	$182.26

DILATOR RX BILIARY 8mx4c 4594

Facility

$1,215.05

Service Code	HCPCS C1876
Hospital Charge Code	270630341
Hospital Revenue Code	278
Min. Negotiated Rate	$29.28
Max. Negotiated Rate	$607.52
Rate for Payer: Aetna Commercial	$461.72
Rate for Payer: Aetna Medicare Advantage	$364.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.84
Rate for Payer: Cigna Commercial	$607.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$267.31
Rate for Payer: Qualcare PPO/HMO/WC	$182.26
Rate for Payer: UnitedHealthcare Community & State	$29.28
Rate for Payer: Wellpoint Medicaid Managed Care	$32.20

Know your out-of-pocket cost for care.

All Charges