Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GASTRECTOMY P DIST; W ROUX-EN

Facility

$23,535.00

Service Code	HCPCS 43633
Hospital Charge Code	1600000636
Hospital Revenue Code	360
Min. Negotiated Rate	$3,530.25
Max. Negotiated Rate	$3,530.25
Rate for Payer: Qualcare PPO/HMO/WC	$3,530.25

GASTRHPHY STR PERF DUOD/GASTC

Facility

$16,639.25

Service Code	HCPCS 43840
Hospital Charge Code	16000967
Hospital Revenue Code	360
Min. Negotiated Rate	$401.01
Max. Negotiated Rate	$16,533.87
Rate for Payer: Aetna Commercial	$12,458.69
Rate for Payer: Aetna Medicare Advantage	$14,840.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,533.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,533.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,580.40
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	$16,533.87
Rate for Payer: Cigna Commercial	$9,181.40
Rate for Payer: Cigna Medicare Advantage	$4,580.40
Rate for Payer: Clover Medicare Advantage	$4,351.38
Rate for Payer: EmblemHealth Commercial	$13,741.20
Rate for Payer: Humana Medicare Advantage	$4,717.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,580.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,991.77
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,495.89
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$401.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,580.40
Rate for Payer: Wellcare Medicare Advantage	$4,580.40
Rate for Payer: Wellpoint Medicaid Managed Care	$440.94

GASTRHPHY STR PERF DUOD/GASTC

Facility

$16,639.25

Service Code	HCPCS 43840
Hospital Charge Code	16000967
Hospital Revenue Code	360
Min. Negotiated Rate	$2,495.89
Max. Negotiated Rate	$2,495.89
Rate for Payer: Qualcare PPO/HMO/WC	$2,495.89

GASTRIC ANALYSIS*****

Facility

$81.00

Hospital Charge Code	8002271
Hospital Revenue Code	279
Min. Negotiated Rate	$12.15
Max. Negotiated Rate	$12.15
Rate for Payer: Qualcare PPO/HMO/WC	$12.15

GASTRIC ANALYSIS*****

Facility

$81.00

Hospital Charge Code	8002271
Hospital Revenue Code	279
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna Commercial	$30.78
Rate for Payer: Aetna Medicare Advantage	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.66
Rate for Payer: Cigna Commercial	$40.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.30
Rate for Payer: Oxford Commercial	$16.20
Rate for Payer: Qualcare PPO/HMO/WC	$12.15
Rate for Payer: UnitedHealthcare Commercial	$16.20
Rate for Payer: UnitedHealthcare Community & State	$1.95
Rate for Payer: Wellpoint Medicaid Managed Care	$2.15

GASTRIC BAND ADJ W/ DISSECTOR

Facility

$14,445.00

Hospital Charge Code	270641522
Hospital Revenue Code	272
Min. Negotiated Rate	$2,166.75
Max. Negotiated Rate	$2,166.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,166.75

GASTRIC BAND ADJ W/ DISSECTOR

Facility

$14,445.00

Hospital Charge Code	270641522
Hospital Revenue Code	272
Min. Negotiated Rate	$348.12
Max. Negotiated Rate	$7,222.50
Rate for Payer: Aetna Commercial	$5,489.10
Rate for Payer: Aetna Medicare Advantage	$4,333.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,683.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,683.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,683.47
Rate for Payer: Cigna Commercial	$7,222.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,333.50
Rate for Payer: Oxford Commercial	$2,889.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,166.75
Rate for Payer: UnitedHealthcare Commercial	$2,889.00
Rate for Payer: UnitedHealthcare Community & State	$348.12
Rate for Payer: Wellpoint Medicaid Managed Care	$382.79

GASTRIC FUNDOPLICATION

Facility

$16,848.77

Service Code	APR-DRG 2322
Min. Negotiated Rate	$16,518.40
Max. Negotiated Rate	$16,848.77
Rate for Payer: UnitedHealthcare Community & State	$16,518.40
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$16,848.77
Rate for Payer: Wellpoint Medicaid Managed Care	$16,518.40

GASTRIC FUNDOPLICATION

Facility

$23,422.50

Service Code	APR-DRG 2323
Min. Negotiated Rate	$22,963.24
Max. Negotiated Rate	$23,422.50
Rate for Payer: UnitedHealthcare Community & State	$22,963.24
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$23,422.50
Rate for Payer: Wellpoint Medicaid Managed Care	$22,963.24

GASTRIC FUNDOPLICATION

Facility

$56,276.06

Service Code	APR-DRG 2324
Min. Negotiated Rate	$55,172.61
Max. Negotiated Rate	$56,276.06
Rate for Payer: UnitedHealthcare Community & State	$55,172.61
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$56,276.06
Rate for Payer: Wellpoint Medicaid Managed Care	$55,172.61

GASTRIC FUNDOPLICATION

Facility

$14,153.59

Service Code	APR-DRG 2321
Min. Negotiated Rate	$13,876.07
Max. Negotiated Rate	$14,153.59
Rate for Payer: UnitedHealthcare Community & State	$13,876.07
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,153.59
Rate for Payer: Wellpoint Medicaid Managed Care	$13,876.07

GASTRIC LAVAGE*******

Facility

$81.00

Hospital Charge Code	8002289
Hospital Revenue Code	279
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna Commercial	$30.78
Rate for Payer: Aetna Medicare Advantage	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.66
Rate for Payer: Cigna Commercial	$40.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.30
Rate for Payer: Oxford Commercial	$16.20
Rate for Payer: Qualcare PPO/HMO/WC	$12.15
Rate for Payer: UnitedHealthcare Commercial	$16.20
Rate for Payer: UnitedHealthcare Community & State	$1.95
Rate for Payer: Wellpoint Medicaid Managed Care	$2.15

GASTRIC LAVAGE*******

Facility

$81.00

Hospital Charge Code	8002289
Hospital Revenue Code	279
Min. Negotiated Rate	$12.15
Max. Negotiated Rate	$12.15
Rate for Payer: Qualcare PPO/HMO/WC	$12.15

GASTRIC LAVAGE/CLOSED SYSTEM**

Facility

$232.00

Hospital Charge Code	8003519
Hospital Revenue Code	279
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$116.00
Rate for Payer: Aetna Commercial	$88.16
Rate for Payer: Aetna Medicare Advantage	$69.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.16
Rate for Payer: Cigna Commercial	$116.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.60
Rate for Payer: Oxford Commercial	$46.40
Rate for Payer: Qualcare PPO/HMO/WC	$34.80
Rate for Payer: UnitedHealthcare Commercial	$46.40
Rate for Payer: UnitedHealthcare Community & State	$5.59
Rate for Payer: Wellpoint Medicaid Managed Care	$6.15

GASTRIC LAVAGE/CLOSED SYSTEM**

Facility

$232.00

Hospital Charge Code	8003519
Hospital Revenue Code	279
Min. Negotiated Rate	$34.80
Max. Negotiated Rate	$34.80
Rate for Payer: Qualcare PPO/HMO/WC	$34.80

GASTRIC TUBE REPLACEMNT DEVICE

Facility

$290.00

Hospital Charge Code	270325686
Hospital Revenue Code	272
Min. Negotiated Rate	$43.50
Max. Negotiated Rate	$43.50
Rate for Payer: Qualcare PPO/HMO/WC	$43.50

GASTRIC TUBE REPLACEMNT DEVICE

Facility

$290.00

Hospital Charge Code	270325686
Hospital Revenue Code	272
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$145.00
Rate for Payer: Aetna Commercial	$110.20
Rate for Payer: Aetna Medicare Advantage	$87.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.95
Rate for Payer: Cigna Commercial	$145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.00
Rate for Payer: Oxford Commercial	$58.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.50
Rate for Payer: UnitedHealthcare Commercial	$58.00
Rate for Payer: UnitedHealthcare Community & State	$6.99
Rate for Payer: Wellpoint Medicaid Managed Care	$7.68

GASTRIN

Facility

$622.00

Service Code	HCPCS 82941
Hospital Charge Code	38472293
Hospital Revenue Code	301
Min. Negotiated Rate	$14.10
Max. Negotiated Rate	$311.00
Rate for Payer: Aetna Commercial	$47.95
Rate for Payer: Aetna Medicare Advantage	$57.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.64
Rate for Payer: Cigna Commercial	$311.00
Rate for Payer: Cigna Medicare Advantage	$17.63
Rate for Payer: Clover Medicare Advantage	$16.75
Rate for Payer: EmblemHealth Commercial	$52.89
Rate for Payer: Humana Medicare Advantage	$18.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.63
Rate for Payer: Wellcare Medicare Advantage	$17.63
Rate for Payer: Wellpoint Medicaid Managed Care	$16.48

GASTRIN

Facility

$622.00

Service Code	HCPCS 82941
Hospital Charge Code	38472293
Hospital Revenue Code	301
Min. Negotiated Rate	$93.30
Max. Negotiated Rate	$93.30
Rate for Payer: Qualcare PPO/HMO/WC	$93.30

GASTRIN SERUM*****

Facility

$227.00

Service Code	HCPCS 82941
Hospital Charge Code	3009996
Hospital Revenue Code	301
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$47.95
Rate for Payer: Aetna Medicare Advantage	$57.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.64
Rate for Payer: Cigna Commercial	$113.50
Rate for Payer: Cigna Medicare Advantage	$17.63
Rate for Payer: Clover Medicare Advantage	$16.75
Rate for Payer: EmblemHealth Commercial	$52.89
Rate for Payer: Humana Medicare Advantage	$18.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.63
Rate for Payer: Wellcare Medicare Advantage	$17.63
Rate for Payer: Wellpoint Medicaid Managed Care	$6.02

GASTRIN SERUM*****

Facility

$227.00

Service Code	HCPCS 82941
Hospital Charge Code	3009996
Hospital Revenue Code	301
Min. Negotiated Rate	$34.05
Max. Negotiated Rate	$34.05
Rate for Payer: Qualcare PPO/HMO/WC	$34.05

GASTRIN, SERUM

Facility

$181.65

Service Code	HCPCS 82941
Hospital Charge Code	3004256
Hospital Revenue Code	301
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$47.95
Rate for Payer: Aetna Medicare Advantage	$57.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.64
Rate for Payer: Cigna Commercial	$90.83
Rate for Payer: Cigna Medicare Advantage	$17.63
Rate for Payer: Clover Medicare Advantage	$16.75
Rate for Payer: EmblemHealth Commercial	$52.89
Rate for Payer: Humana Medicare Advantage	$18.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.63
Rate for Payer: Wellcare Medicare Advantage	$17.63
Rate for Payer: Wellpoint Medicaid Managed Care	$4.81

GASTRIN, SERUM

Facility

$181.65

Service Code	HCPCS 82941
Hospital Charge Code	3004256
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

GASTRIN,SERUM

Facility

$667.59

Service Code	HCPCS 82941
Hospital Charge Code	39900084
Hospital Revenue Code	301
Min. Negotiated Rate	$14.10
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$47.95
Rate for Payer: Aetna Medicare Advantage	$57.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.64
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$17.63
Rate for Payer: Clover Medicare Advantage	$16.75
Rate for Payer: EmblemHealth Commercial	$52.89
Rate for Payer: Humana Medicare Advantage	$18.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.63
Rate for Payer: Wellcare Medicare Advantage	$17.63
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

GASTRIN,SERUM

Facility

$667.59

Service Code	HCPCS 82941
Hospital Charge Code	39900084
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

Know your out-of-pocket cost for care.

All Charges