Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ENDOSCOPIC INJECTION/IMPLANT

Facility

$15,142.80

Service Code	HCPCS 51715
Hospital Charge Code	1600000470
Hospital Revenue Code	360
Min. Negotiated Rate	$2,271.42
Max. Negotiated Rate	$2,271.42
Rate for Payer: Qualcare PPO/HMO/WC	$2,271.42

ENDOSCOPIC INJECTION/IMPLANT

Facility

$15,142.80

Service Code	HCPCS 51715
Hospital Charge Code	1600000470
Hospital Revenue Code	360
Min. Negotiated Rate	$364.94
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	$1,355.00
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	$4,542.84
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,271.42
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$364.94
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	$401.28

ENDOSCOPIC PLANTAR FASCITMY-LT

Facility

$21,064.35

Service Code	HCPCS 29893
Hospital Charge Code	16000257
Hospital Revenue Code	360
Min. Negotiated Rate	$507.65
Max. Negotiated Rate	$14,031.70
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
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	$14,031.70
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,319.31
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,159.65
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$507.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$558.21

ENDOSCOPIC PLANTAR FASCITMY-LT

Facility

$21,064.35

Service Code	HCPCS 29893
Hospital Charge Code	16000257
Hospital Revenue Code	360
Min. Negotiated Rate	$3,159.65
Max. Negotiated Rate	$3,159.65
Rate for Payer: Qualcare PPO/HMO/WC	$3,159.65

ENDOSCOPIC US****

Facility

$350.00

Hospital Charge Code	2300905
Hospital Revenue Code	759
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

ENDOSCOPIC US****

Facility

$350.00

Hospital Charge Code	2300905
Hospital Revenue Code	759
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

ENDOSCOPIC US W/NDL ASPIR BX

Facility

$1,356.85

Hospital Charge Code	2300900
Hospital Revenue Code	750
Min. Negotiated Rate	$32.70
Max. Negotiated Rate	$678.42
Rate for Payer: Aetna Commercial	$515.60
Rate for Payer: Aetna Medicare Advantage	$407.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$346.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$346.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$346.00
Rate for Payer: Cigna Commercial	$678.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$407.06
Rate for Payer: Qualcare PPO/HMO/WC	$203.53
Rate for Payer: UnitedHealthcare Community & State	$32.70
Rate for Payer: Wellpoint Medicaid Managed Care	$35.96

ENDOSCOPIC US W/NDL ASPIR BX

Facility

$1,356.85

Hospital Charge Code	2300900
Hospital Revenue Code	750
Min. Negotiated Rate	$203.53
Max. Negotiated Rate	$203.53
Rate for Payer: Qualcare PPO/HMO/WC	$203.53

ENDOSCOPIC W/ MIX TIP 5MMX30CM

Facility

$470.00

Hospital Charge Code	270670802
Hospital Revenue Code	272
Min. Negotiated Rate	$70.50
Max. Negotiated Rate	$70.50
Rate for Payer: Qualcare PPO/HMO/WC	$70.50

ENDOSCOPIC W/ MIX TIP 5MMX30CM

Facility

$470.00

Hospital Charge Code	270670802
Hospital Revenue Code	272
Min. Negotiated Rate	$11.33
Max. Negotiated Rate	$235.00
Rate for Payer: Aetna Commercial	$178.60
Rate for Payer: Aetna Medicare Advantage	$141.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.85
Rate for Payer: Cigna Commercial	$235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.00
Rate for Payer: Oxford Commercial	$94.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.50
Rate for Payer: UnitedHealthcare Commercial	$94.00
Rate for Payer: UnitedHealthcare Community & State	$11.33
Rate for Payer: Wellpoint Medicaid Managed Care	$12.46

ENDOSCOP MULTIBAND LIGAT SET 6

Facility

$360.00

Hospital Charge Code	270700680
Hospital Revenue Code	272
Min. Negotiated Rate	$8.68
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna Commercial	$136.80
Rate for Payer: Aetna Medicare Advantage	$108.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.80
Rate for Payer: Cigna Commercial	$180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.00
Rate for Payer: Oxford Commercial	$72.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.00
Rate for Payer: UnitedHealthcare Commercial	$72.00
Rate for Payer: UnitedHealthcare Community & State	$8.68
Rate for Payer: Wellpoint Medicaid Managed Care	$9.54

ENDOSCOP MULTIBAND LIGAT SET 6

Facility

$360.00

Hospital Charge Code	270700680
Hospital Revenue Code	272
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$54.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.00

ENDOSCOPY 1-2 HRS W/ > FIVE BX

Facility

$10,625.00

Hospital Charge Code	2300076
Hospital Revenue Code	750
Min. Negotiated Rate	$1,593.75
Max. Negotiated Rate	$1,593.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,593.75

ENDOSCOPY 1-2 HRS W/ > FIVE BX

Facility

$10,625.00

Hospital Charge Code	2300076
Hospital Revenue Code	750
Min. Negotiated Rate	$256.06
Max. Negotiated Rate	$5,312.50
Rate for Payer: Aetna Commercial	$4,037.50
Rate for Payer: Aetna Medicare Advantage	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,709.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,709.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,709.38
Rate for Payer: Cigna Commercial	$5,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,187.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,593.75
Rate for Payer: UnitedHealthcare Community & State	$256.06
Rate for Payer: Wellpoint Medicaid Managed Care	$281.56

ENDOSCOPY 1-2 HRS WITH FIVE BX

Facility

$9,375.00

Hospital Charge Code	2300075
Hospital Revenue Code	750
Min. Negotiated Rate	$225.94
Max. Negotiated Rate	$4,687.50
Rate for Payer: Aetna Commercial	$3,562.50
Rate for Payer: Aetna Medicare Advantage	$2,812.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,390.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,390.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,390.62
Rate for Payer: Cigna Commercial	$4,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,812.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,406.25
Rate for Payer: UnitedHealthcare Community & State	$225.94
Rate for Payer: Wellpoint Medicaid Managed Care	$248.44

ENDOSCOPY 1-2 HRS WITH FIVE BX

Facility

$9,375.00

Hospital Charge Code	2300075
Hospital Revenue Code	750
Min. Negotiated Rate	$1,406.25
Max. Negotiated Rate	$1,406.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,406.25

ENDOSCOPY 1-2 HRS WITH FOUR BX

Facility

$8,125.00

Hospital Charge Code	2300074
Hospital Revenue Code	750
Min. Negotiated Rate	$195.81
Max. Negotiated Rate	$4,062.50
Rate for Payer: Aetna Commercial	$3,087.50
Rate for Payer: Aetna Medicare Advantage	$2,437.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,071.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,071.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,071.88
Rate for Payer: Cigna Commercial	$4,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,437.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,218.75
Rate for Payer: UnitedHealthcare Community & State	$195.81
Rate for Payer: Wellpoint Medicaid Managed Care	$215.31

ENDOSCOPY 1-2 HRS WITH FOUR BX

Facility

$8,125.00

Hospital Charge Code	2300074
Hospital Revenue Code	750
Min. Negotiated Rate	$1,218.75
Max. Negotiated Rate	$1,218.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,218.75

ENDOSCOPY 1-2 HRS WITH ONE BX

Facility

$4,375.00

Hospital Charge Code	2300071
Hospital Revenue Code	750
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$656.25
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

ENDOSCOPY 1-2 HRS WITH ONE BX

Facility

$4,375.00

Hospital Charge Code	2300071
Hospital Revenue Code	750
Min. Negotiated Rate	$105.44
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,662.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,312.50
Rate for Payer: Qualcare PPO/HMO/WC	$656.25
Rate for Payer: UnitedHealthcare Community & State	$105.44
Rate for Payer: Wellpoint Medicaid Managed Care	$115.94

ENDOSCOPY 1-2 HRS WITHOUT BX

Facility

$3,125.00

Hospital Charge Code	2300070
Hospital Revenue Code	750
Min. Negotiated Rate	$468.75
Max. Negotiated Rate	$468.75
Rate for Payer: Qualcare PPO/HMO/WC	$468.75

ENDOSCOPY 1-2 HRS WITHOUT BX

Facility

$3,125.00

Hospital Charge Code	2300070
Hospital Revenue Code	750
Min. Negotiated Rate	$75.31
Max. Negotiated Rate	$1,562.50
Rate for Payer: Aetna Commercial	$1,187.50
Rate for Payer: Aetna Medicare Advantage	$937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$796.88
Rate for Payer: Cigna Commercial	$1,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$937.50
Rate for Payer: Qualcare PPO/HMO/WC	$468.75
Rate for Payer: UnitedHealthcare Community & State	$75.31
Rate for Payer: Wellpoint Medicaid Managed Care	$82.81

ENDOSCOPY 1-2HRS WITH THREE BX

Facility

$6,875.00

Hospital Charge Code	2300073
Hospital Revenue Code	750
Min. Negotiated Rate	$165.69
Max. Negotiated Rate	$3,437.50
Rate for Payer: Aetna Commercial	$2,612.50
Rate for Payer: Aetna Medicare Advantage	$2,062.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,753.12
Rate for Payer: Cigna Commercial	$3,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,062.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25
Rate for Payer: UnitedHealthcare Community & State	$165.69
Rate for Payer: Wellpoint Medicaid Managed Care	$182.19

ENDOSCOPY 1-2HRS WITH THREE BX

Facility

$6,875.00

Hospital Charge Code	2300073
Hospital Revenue Code	750
Min. Negotiated Rate	$1,031.25
Max. Negotiated Rate	$1,031.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25

ENDOSCOPY 1-2 HRS WITH TWO BX

Facility

$5,625.00

Hospital Charge Code	2300072
Hospital Revenue Code	750
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$843.75
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

Know your out-of-pocket cost for care.

All Charges