Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH TRANSENDOSCOPIC BALLOON DILATION OF ESOPHAGUS (LESS THAN 30 MM DIAMETER)

Facility

$8,229.07

Service Code	CPT 43249
Hospital Revenue Code	750
Min. Negotiated Rate	$255.55
Max. Negotiated Rate	$8,229.07
Rate for Payer: Aetna Commercial	$6,200.81
Rate for Payer: Aetna Medicare Advantage	$7,386.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,229.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,229.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,279.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,229.07
Rate for Payer: Cigna Commercial	$4,569.67
Rate for Payer: Cigna Medicare Advantage	$2,279.71
Rate for Payer: Clover Medicare Advantage	$2,165.72
Rate for Payer: EmblemHealth Commercial	$6,839.13
Rate for Payer: Humana Medicare Advantage	$2,348.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,279.71
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,279.71
Rate for Payer: Wellcare Medicare Advantage	$2,279.71
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,829.61

ESOPHAGOGASTROENTEROSCOPY***

Facility

$340.00

Hospital Charge Code	2300168
Hospital Revenue Code	759
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$170.00
Rate for Payer: Aetna Commercial	$129.20
Rate for Payer: Aetna Medicare Advantage	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.70
Rate for Payer: Cigna Commercial	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.00
Rate for Payer: UnitedHealthcare Community & State	$8.19
Rate for Payer: Wellpoint Medicaid Managed Care	$9.01

ESOPHAGOGASTROENTEROSCOPY***

Facility

$340.00

Hospital Charge Code	2300168
Hospital Revenue Code	759
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.00

ESOPHAGOGASTROJEJUNOSCOPY***

Facility

$263.00

Hospital Charge Code	2300267
Hospital Revenue Code	759
Min. Negotiated Rate	$39.45
Max. Negotiated Rate	$39.45
Rate for Payer: Qualcare PPO/HMO/WC	$39.45

ESOPHAGOGASTROJEJUNOSCOPY***

Facility

$263.00

Hospital Charge Code	2300267
Hospital Revenue Code	759
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$131.50
Rate for Payer: Aetna Commercial	$99.94
Rate for Payer: Aetna Medicare Advantage	$78.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.06
Rate for Payer: Cigna Commercial	$131.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.90
Rate for Payer: Qualcare PPO/HMO/WC	$39.45
Rate for Payer: UnitedHealthcare Community & State	$6.34
Rate for Payer: Wellpoint Medicaid Managed Care	$6.97

ESOPHAGOGASTROSCOPY***

Facility

$263.00

Hospital Charge Code	2300127
Hospital Revenue Code	759
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$131.50
Rate for Payer: Aetna Commercial	$99.94
Rate for Payer: Aetna Medicare Advantage	$78.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.06
Rate for Payer: Cigna Commercial	$131.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.90
Rate for Payer: Qualcare PPO/HMO/WC	$39.45
Rate for Payer: UnitedHealthcare Community & State	$6.34
Rate for Payer: Wellpoint Medicaid Managed Care	$6.97

ESOPHAGOGASTROSCOPY***

Facility

$263.00

Hospital Charge Code	2300127
Hospital Revenue Code	759
Min. Negotiated Rate	$39.45
Max. Negotiated Rate	$39.45
Rate for Payer: Qualcare PPO/HMO/WC	$39.45

ESOPHAGOSCOPY***

Facility

$263.00

Hospital Charge Code	2300275
Hospital Revenue Code	759
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$131.50
Rate for Payer: Aetna Commercial	$99.94
Rate for Payer: Aetna Medicare Advantage	$78.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.06
Rate for Payer: Cigna Commercial	$131.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.90
Rate for Payer: Qualcare PPO/HMO/WC	$39.45
Rate for Payer: UnitedHealthcare Community & State	$6.34
Rate for Payer: Wellpoint Medicaid Managed Care	$6.97

ESOPHAGOSCOPY***

Facility

$263.00

Hospital Charge Code	2300275
Hospital Revenue Code	759
Min. Negotiated Rate	$39.45
Max. Negotiated Rate	$39.45
Rate for Payer: Qualcare PPO/HMO/WC	$39.45

ESOPHAGOSCOPY FLEXIBLE BRUSH

Facility

$7,963.40

Service Code	HCPCS 43200
Hospital Charge Code	16000641
Hospital Revenue Code	360
Min. Negotiated Rate	$191.92
Max. Negotiated Rate	$5,311.00
Rate for Payer: Aetna Commercial	$2,930.85
Rate for Payer: Aetna Medicare Advantage	$3,491.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,077.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,889.52
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: Cigna Medicare Advantage	$1,077.52
Rate for Payer: Clover Medicare Advantage	$1,023.64
Rate for Payer: EmblemHealth Commercial	$3,232.56
Rate for Payer: Humana Medicare Advantage	$1,109.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,077.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,389.02
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,194.51
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$191.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,077.52
Rate for Payer: Wellcare Medicare Advantage	$1,077.52
Rate for Payer: Wellpoint Medicaid Managed Care	$211.03

ESOPHAGOSCOPY FLEXIBLE BRUSH

Facility

$7,963.40

Service Code	HCPCS 43200
Hospital Charge Code	16000641
Hospital Revenue Code	360
Min. Negotiated Rate	$1,194.51
Max. Negotiated Rate	$1,194.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,194.51

ESOPHAGOSCOPY W/BAND LIGAT****

Facility

$909.00

Hospital Charge Code	2300012
Hospital Revenue Code	759
Min. Negotiated Rate	$136.35
Max. Negotiated Rate	$136.35
Rate for Payer: Qualcare PPO/HMO/WC	$136.35

ESOPHAGOSCOPY W/BAND LIGAT****

Facility

$909.00

Hospital Charge Code	2300012
Hospital Revenue Code	759
Min. Negotiated Rate	$21.91
Max. Negotiated Rate	$454.50
Rate for Payer: Aetna Commercial	$345.42
Rate for Payer: Aetna Medicare Advantage	$272.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$231.79
Rate for Payer: Cigna Commercial	$454.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.70
Rate for Payer: Qualcare PPO/HMO/WC	$136.35
Rate for Payer: UnitedHealthcare Community & State	$21.91
Rate for Payer: Wellpoint Medicaid Managed Care	$24.09

ESOPHAGOSCOPY W/BIOPSY****

Facility

$909.00

Hospital Charge Code	2300013
Hospital Revenue Code	759
Min. Negotiated Rate	$136.35
Max. Negotiated Rate	$136.35
Rate for Payer: Qualcare PPO/HMO/WC	$136.35

ESOPHAGOSCOPY W/BIOPSY****

Facility

$909.00

Hospital Charge Code	2300013
Hospital Revenue Code	759
Min. Negotiated Rate	$21.91
Max. Negotiated Rate	$454.50
Rate for Payer: Aetna Commercial	$345.42
Rate for Payer: Aetna Medicare Advantage	$272.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$231.79
Rate for Payer: Cigna Commercial	$454.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.70
Rate for Payer: Qualcare PPO/HMO/WC	$136.35
Rate for Payer: UnitedHealthcare Community & State	$21.91
Rate for Payer: Wellpoint Medicaid Managed Care	$24.09

ESOPHAGOSCOPY W/DILATION***

Facility

$962.00

Service Code	HCPCS 43450
Hospital Charge Code	2300184
Hospital Revenue Code	759
Min. Negotiated Rate	$23.18
Max. Negotiated Rate	$3,889.52
Rate for Payer: Aetna Commercial	$2,930.85
Rate for Payer: Aetna Medicare Advantage	$3,491.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,077.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,889.52
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: Cigna Medicare Advantage	$1,077.52
Rate for Payer: Clover Medicare Advantage	$1,023.64
Rate for Payer: EmblemHealth Commercial	$3,232.56
Rate for Payer: Humana Medicare Advantage	$1,109.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,077.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$288.60
Rate for Payer: Qualcare PPO/HMO/WC	$144.30
Rate for Payer: UnitedHealthcare Community & State	$23.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,077.52
Rate for Payer: Wellcare Medicare Advantage	$1,077.52
Rate for Payer: Wellpoint Medicaid Managed Care	$25.49

ESOPHAGOSCOPY W/DILATION***

Facility

$962.00

Service Code	HCPCS 43450
Hospital Charge Code	2300184
Hospital Revenue Code	759
Min. Negotiated Rate	$144.30
Max. Negotiated Rate	$144.30
Rate for Payer: Qualcare PPO/HMO/WC	$144.30

ESOPHAGOSCOPY W/SAVRY DILATION

Facility

$406.80

Hospital Charge Code	2300606
Hospital Revenue Code	759
Min. Negotiated Rate	$61.02
Max. Negotiated Rate	$61.02
Rate for Payer: Qualcare PPO/HMO/WC	$61.02

ESOPHAGOSCOPY W/SAVRY DILATION

Facility

$406.80

Hospital Charge Code	2300606
Hospital Revenue Code	759
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$203.40
Rate for Payer: Aetna Commercial	$154.58
Rate for Payer: Aetna Medicare Advantage	$122.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.73
Rate for Payer: Cigna Commercial	$203.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.04
Rate for Payer: Qualcare PPO/HMO/WC	$61.02
Rate for Payer: UnitedHealthcare Community & State	$9.80
Rate for Payer: Wellpoint Medicaid Managed Care	$10.78

ESOPHAGUS

Facility

$642.00

Service Code	HCPCS 74220
Hospital Charge Code	94061135
Hospital Revenue Code	320
Min. Negotiated Rate	$96.30
Max. Negotiated Rate	$96.30
Rate for Payer: Qualcare PPO/HMO/WC	$96.30

ESOPHAGUS

Facility

$642.00

Service Code	HCPCS 74220
Hospital Charge Code	94061135
Hospital Revenue Code	320
Min. Negotiated Rate	$15.47
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.19
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.60
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$96.30
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$15.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$17.01

ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH MUCOSAL ATTACHED TELEMETRY PH ELECTRODE PLACEMENT, RECORDING, ANALYSIS AND INTERPRETATION

Facility

$3,682.65

Service Code	CPT 91035
Hospital Revenue Code	750
Min. Negotiated Rate	$350.42
Max. Negotiated Rate	$3,682.65
Rate for Payer: Aetna Commercial	$2,774.97
Rate for Payer: Aetna Medicare Advantage	$3,305.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,682.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,682.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,020.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,682.65
Rate for Payer: Cigna Commercial	$2,044.99
Rate for Payer: Cigna Medicare Advantage	$1,020.21
Rate for Payer: Clover Medicare Advantage	$969.20
Rate for Payer: EmblemHealth Commercial	$3,060.63
Rate for Payer: Humana Medicare Advantage	$1,050.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,020.21
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,020.21
Rate for Payer: Wellcare Medicare Advantage	$1,020.21

ESOPHAGUS SURGERY PROCEDURE

Facility

$3,487.18

Service Code	HCPCS 43499
Hospital Charge Code	16000966
Hospital Revenue Code	360
Min. Negotiated Rate	$523.08
Max. Negotiated Rate	$523.08
Rate for Payer: Qualcare PPO/HMO/WC	$523.08

ESOPHAGUS SURGERY PROCEDURE

Facility

$3,487.18

Service Code	HCPCS 43499
Hospital Charge Code	16000966
Hospital Revenue Code	360
Min. Negotiated Rate	$84.04
Max. Negotiated Rate	$5,311.00
Rate for Payer: Aetna Commercial	$2,930.85
Rate for Payer: Aetna Medicare Advantage	$3,491.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,077.52
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	$3,889.52
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: Cigna Medicare Advantage	$1,077.52
Rate for Payer: Clover Medicare Advantage	$1,023.64
Rate for Payer: EmblemHealth Commercial	$3,232.56
Rate for Payer: Humana Medicare Advantage	$1,109.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,077.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,046.15
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$523.08
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$84.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,077.52
Rate for Payer: Wellcare Medicare Advantage	$1,077.52
Rate for Payer: Wellpoint Medicaid Managed Care	$92.41

ESSURE

Facility

$8,750.00

Hospital Charge Code	270658503
Hospital Revenue Code	270
Min. Negotiated Rate	$210.88
Max. Negotiated Rate	$4,375.00
Rate for Payer: Aetna Commercial	$3,325.00
Rate for Payer: Aetna Medicare Advantage	$2,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,231.25
Rate for Payer: Cigna Commercial	$4,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,625.00
Rate for Payer: Oxford Commercial	$1,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50
Rate for Payer: UnitedHealthcare Commercial	$1,750.00
Rate for Payer: UnitedHealthcare Community & State	$210.88
Rate for Payer: Wellpoint Medicaid Managed Care	$231.88

Know your out-of-pocket cost for care.

All Charges