Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ENDOSCOPY 1-2 HRS WITH TWO BX

Facility

$5,625.00

Hospital Charge Code	2300072
Hospital Revenue Code	750
Min. Negotiated Rate	$135.56
Max. Negotiated Rate	$2,812.50
Rate for Payer: Aetna Commercial	$2,137.50
Rate for Payer: Aetna Medicare Advantage	$1,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.38
Rate for Payer: Cigna Commercial	$2,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,687.50
Rate for Payer: Qualcare PPO/HMO/WC	$843.75
Rate for Payer: UnitedHealthcare Community & State	$135.56
Rate for Payer: Wellpoint Medicaid Managed Care	$149.06

ENDOSCOPY < 1 HR W/ > FIVE BX

Facility

$9,375.00

Hospital Charge Code	2300066
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 HR W/ > FIVE BX

Facility

$9,375.00

Hospital Charge Code	2300066
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 HR WITH FIVE BX

Facility

$8,125.00

Hospital Charge Code	2300065
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 HR WITH FIVE BX

Facility

$8,125.00

Hospital Charge Code	2300065
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 HR WITH FOUR BX

Facility

$6,875.00

Hospital Charge Code	2300064
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 HR WITH FOUR BX

Facility

$6,875.00

Hospital Charge Code	2300064
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 HR WITH ONE BX

Facility

$3,125.00

Hospital Charge Code	2300061
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 HR WITH ONE BX

Facility

$3,125.00

Hospital Charge Code	2300061
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 HR WITHOUT BX

Facility

$1,875.00

Hospital Charge Code	2300060
Hospital Revenue Code	750
Min. Negotiated Rate	$45.19
Max. Negotiated Rate	$937.50
Rate for Payer: Aetna Commercial	$712.50
Rate for Payer: Aetna Medicare Advantage	$562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$478.12
Rate for Payer: Cigna Commercial	$937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$562.50
Rate for Payer: Qualcare PPO/HMO/WC	$281.25
Rate for Payer: UnitedHealthcare Community & State	$45.19
Rate for Payer: Wellpoint Medicaid Managed Care	$49.69

ENDOSCOPY < 1 HR WITHOUT BX

Facility

$1,875.00

Hospital Charge Code	2300060
Hospital Revenue Code	750
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$281.25
Rate for Payer: Qualcare PPO/HMO/WC	$281.25

ENDOSCOPY < 1 HR WITH THREE BX

Facility

$5,625.00

Hospital Charge Code	2300063
Hospital Revenue Code	750
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$843.75
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

ENDOSCOPY < 1 HR WITH THREE BX

Facility

$5,625.00

Hospital Charge Code	2300063
Hospital Revenue Code	750
Min. Negotiated Rate	$135.56
Max. Negotiated Rate	$2,812.50
Rate for Payer: Aetna Commercial	$2,137.50
Rate for Payer: Aetna Medicare Advantage	$1,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.38
Rate for Payer: Cigna Commercial	$2,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,687.50
Rate for Payer: Qualcare PPO/HMO/WC	$843.75
Rate for Payer: UnitedHealthcare Community & State	$135.56
Rate for Payer: Wellpoint Medicaid Managed Care	$149.06

ENDOSCOPY < 1 HR WITH TWO BX

Facility

$4,375.00

Hospital Charge Code	2300062
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 HR WITH TWO BX

Facility

$4,375.00

Hospital Charge Code	2300062
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 PROCEDURE < 1 HR

Facility

$3,125.00

Hospital Charge Code	2300082
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 PROCEDURE < 1 HR

Facility

$3,125.00

Hospital Charge Code	2300082
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 PROCEDURE >1 HR

Facility

$3,974.24

Hospital Charge Code	2300083
Hospital Revenue Code	750
Min. Negotiated Rate	$95.78
Max. Negotiated Rate	$1,987.12
Rate for Payer: Aetna Commercial	$1,510.21
Rate for Payer: Aetna Medicare Advantage	$1,192.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,013.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,013.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,013.43
Rate for Payer: Cigna Commercial	$1,987.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,192.27
Rate for Payer: Qualcare PPO/HMO/WC	$596.14
Rate for Payer: UnitedHealthcare Community & State	$95.78
Rate for Payer: Wellpoint Medicaid Managed Care	$105.32

ENDOSCOPY 1 PROCEDURE >1 HR

Facility

$3,974.24

Hospital Charge Code	2300083
Hospital Revenue Code	750
Min. Negotiated Rate	$596.14
Max. Negotiated Rate	$596.14
Rate for Payer: Qualcare PPO/HMO/WC	$596.14

ENDOSCOPY 2 PROCEDURES < 1 HR

Facility

$6,250.00

Hospital Charge Code	2300084
Hospital Revenue Code	750
Min. Negotiated Rate	$150.62
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$150.62
Rate for Payer: Wellpoint Medicaid Managed Care	$165.62

ENDOSCOPY 2 PROCEDURES < 1 HR

Facility

$6,250.00

Hospital Charge Code	2300084
Hospital Revenue Code	750
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$937.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

ENDOSCOPY 2 PROCEDURES > 1 HR

Facility

$7,948.47

Hospital Charge Code	2300085
Hospital Revenue Code	750
Min. Negotiated Rate	$1,192.27
Max. Negotiated Rate	$1,192.27
Rate for Payer: Qualcare PPO/HMO/WC	$1,192.27

ENDOSCOPY 2 PROCEDURES > 1 HR

Facility

$7,948.47

Hospital Charge Code	2300085
Hospital Revenue Code	750
Min. Negotiated Rate	$191.56
Max. Negotiated Rate	$3,974.24
Rate for Payer: Aetna Commercial	$3,020.42
Rate for Payer: Aetna Medicare Advantage	$2,384.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,026.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,026.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,026.86
Rate for Payer: Cigna Commercial	$3,974.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,384.54
Rate for Payer: Qualcare PPO/HMO/WC	$1,192.27
Rate for Payer: UnitedHealthcare Community & State	$191.56
Rate for Payer: Wellpoint Medicaid Managed Care	$210.63

ENDOSCOPY 3 PROCEDURES < 1 HR

Facility

$7,500.00

Hospital Charge Code	2300086
Hospital Revenue Code	750
Min. Negotiated Rate	$180.75
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$180.75
Rate for Payer: Wellpoint Medicaid Managed Care	$198.75

ENDOSCOPY 3 PROCEDURES < 1 HR

Facility

$7,500.00

Hospital Charge Code	2300086
Hospital Revenue Code	750
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

Know your out-of-pocket cost for care.

All Charges