Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PROCTOSGMDOSCP RIGID W/DECMP**

Facility

$909.00

Hospital Charge Code	2300017
Hospital Revenue Code	759
Min. Negotiated Rate	$136.35
Max. Negotiated Rate	$136.35
Rate for Payer: Qualcare PPO/HMO/WC	$136.35

PROCTOSIGMOIDOSCOPY SDS

Facility

$3,489.62

Service Code	HCPCS 45300
Hospital Charge Code	16000485
Hospital Revenue Code	360
Min. Negotiated Rate	$523.44
Max. Negotiated Rate	$523.44
Rate for Payer: Qualcare PPO/HMO/WC	$523.44

PROCTOSIGMOIDOSCOPY SDS

Facility

$3,489.62

Service Code	HCPCS 45300
Hospital Charge Code	16000485
Hospital Revenue Code	360
Min. Negotiated Rate	$84.10
Max. Negotiated Rate	$3,988.03
Rate for Payer: Aetna Commercial	$3,005.08
Rate for Payer: Aetna Medicare Advantage	$3,579.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,988.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,988.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,104.81
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	$3,988.03
Rate for Payer: Cigna Commercial	$2,214.60
Rate for Payer: Cigna Medicare Advantage	$1,104.81
Rate for Payer: Clover Medicare Advantage	$1,049.57
Rate for Payer: EmblemHealth Commercial	$3,314.43
Rate for Payer: Humana Medicare Advantage	$1,137.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,104.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,046.89
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$523.44
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$84.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,104.81
Rate for Payer: Wellcare Medicare Advantage	$1,104.81
Rate for Payer: Wellpoint Medicaid Managed Care	$92.47

PROCUCT AUTOLOG PLASMA

Facility

$203.55

Hospital Charge Code	3100369
Hospital Revenue Code	390
Min. Negotiated Rate	$30.53
Max. Negotiated Rate	$30.53
Rate for Payer: Qualcare PPO/HMO/WC	$30.53

PROCUCT AUTOLOG PLASMA

Facility

$203.55

Hospital Charge Code	3100369
Hospital Revenue Code	390
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$77.35
Rate for Payer: Aetna Medicare Advantage	$61.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.91
Rate for Payer: Cigna Commercial	$101.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.06
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.53
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$4.91
Rate for Payer: Wellpoint Medicaid Managed Care	$5.39

PRO-DENSE INJ 5CC

Facility

$17,292.00

Service Code	HCPCS C1713
Hospital Charge Code	270702616
Hospital Revenue Code	278
Min. Negotiated Rate	$2,593.80
Max. Negotiated Rate	$4,184.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,458.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,184.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,804.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,593.80

PRO-DENSE INJ 5CC

Facility

$17,292.00

Service Code	HCPCS C1713
Hospital Charge Code	270702616
Hospital Revenue Code	278
Min. Negotiated Rate	$416.74
Max. Negotiated Rate	$8,646.00
Rate for Payer: Aetna Commercial	$6,570.96
Rate for Payer: Aetna Medicare Advantage	$5,187.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,409.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,409.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,458.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,409.46
Rate for Payer: Cigna Commercial	$8,646.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,184.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,804.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,593.80
Rate for Payer: UnitedHealthcare Community & State	$416.74
Rate for Payer: Wellpoint Medicaid Managed Care	$458.24

PRO-DENSE INJECTABLE

Facility

$23,040.00

Service Code	HCPCS C1713
Hospital Charge Code	270667309
Hospital Revenue Code	278
Min. Negotiated Rate	$555.26
Max. Negotiated Rate	$11,520.00
Rate for Payer: Aetna Commercial	$8,755.20
Rate for Payer: Aetna Medicare Advantage	$6,912.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,875.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,875.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,608.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,875.20
Rate for Payer: Cigna Commercial	$11,520.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,575.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,068.80
Rate for Payer: Qualcare PPO/HMO/WC	$3,456.00
Rate for Payer: UnitedHealthcare Community & State	$555.26
Rate for Payer: Wellpoint Medicaid Managed Care	$610.56

PRO-DENSE INJECTABLE

Facility

$23,040.00

Service Code	HCPCS C1713
Hospital Charge Code	270667309
Hospital Revenue Code	278
Min. Negotiated Rate	$3,456.00
Max. Negotiated Rate	$5,575.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,608.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,575.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,068.80
Rate for Payer: Qualcare PPO/HMO/WC	$3,456.00

PRODISC-C DEEP IMPL LG 6MM

Facility

$29,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270692629
Hospital Revenue Code	278
Min. Negotiated Rate	$4,462.50
Max. Negotiated Rate	$7,199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,545.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50

PRODISC-C DEEP IMPL LG 6MM

Facility

$29,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270692629
Hospital Revenue Code	278
Min. Negotiated Rate	$716.98
Max. Negotiated Rate	$14,875.00
Rate for Payer: Aetna Commercial	$11,305.00
Rate for Payer: Aetna Medicare Advantage	$8,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,586.25
Rate for Payer: Cigna Commercial	$14,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,545.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50
Rate for Payer: UnitedHealthcare Community & State	$716.98
Rate for Payer: Wellpoint Medicaid Managed Care	$788.38

PRODISC-C IMPL MED .5MM

Facility

$29,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270692980
Hospital Revenue Code	278
Min. Negotiated Rate	$716.98
Max. Negotiated Rate	$14,875.00
Rate for Payer: Aetna Commercial	$11,305.00
Rate for Payer: Aetna Medicare Advantage	$8,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,586.25
Rate for Payer: Cigna Commercial	$14,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,545.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50
Rate for Payer: UnitedHealthcare Community & State	$716.98
Rate for Payer: Wellpoint Medicaid Managed Care	$788.38

PRODISC-C IMPL MED .5MM

Facility

$29,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270692980
Hospital Revenue Code	278
Min. Negotiated Rate	$4,462.50
Max. Negotiated Rate	$7,199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,545.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50

PRODISC-C INTER PROS LARGE 6MM

Facility

$29,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270693729
Hospital Revenue Code	278
Min. Negotiated Rate	$4,462.50
Max. Negotiated Rate	$7,199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,545.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50

PRODISC-C INTER PROS LARGE 6MM

Facility

$29,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270693729
Hospital Revenue Code	278
Min. Negotiated Rate	$716.98
Max. Negotiated Rate	$14,875.00
Rate for Payer: Aetna Commercial	$11,305.00
Rate for Payer: Aetna Medicare Advantage	$8,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,586.25
Rate for Payer: Cigna Commercial	$14,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,545.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50
Rate for Payer: UnitedHealthcare Community & State	$716.98
Rate for Payer: Wellpoint Medicaid Managed Care	$788.38

PRODISC-C INTERV DISC PROS MOD

Facility

$29,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270693191
Hospital Revenue Code	278
Min. Negotiated Rate	$4,462.50
Max. Negotiated Rate	$7,199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,545.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50

PRODISC-C INTERV DISC PROS MOD

Facility

$29,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270693191
Hospital Revenue Code	278
Min. Negotiated Rate	$716.98
Max. Negotiated Rate	$14,875.00
Rate for Payer: Aetna Commercial	$11,305.00
Rate for Payer: Aetna Medicare Advantage	$8,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,586.25
Rate for Payer: Cigna Commercial	$14,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,545.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50
Rate for Payer: UnitedHealthcare Community & State	$716.98
Rate for Payer: Wellpoint Medicaid Managed Care	$788.38

PRODISC-C L 17X14MMX5MM

Facility

$29,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270697230
Hospital Revenue Code	278
Min. Negotiated Rate	$4,462.50
Max. Negotiated Rate	$7,199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,545.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50

PRODISC-C L 17X14MMX5MM

Facility

$29,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270697230
Hospital Revenue Code	278
Min. Negotiated Rate	$716.98
Max. Negotiated Rate	$14,875.00
Rate for Payer: Aetna Commercial	$11,305.00
Rate for Payer: Aetna Medicare Advantage	$8,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,586.25
Rate for Payer: Cigna Commercial	$14,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,545.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50
Rate for Payer: UnitedHealthcare Community & State	$716.98
Rate for Payer: Wellpoint Medicaid Managed Care	$788.38

PRODISC-C MOLYB 12X15X6MM

Facility

$29,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270694331
Hospital Revenue Code	278
Min. Negotiated Rate	$716.98
Max. Negotiated Rate	$14,875.00
Rate for Payer: Aetna Commercial	$11,305.00
Rate for Payer: Aetna Medicare Advantage	$8,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,586.25
Rate for Payer: Cigna Commercial	$14,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,545.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50
Rate for Payer: UnitedHealthcare Community & State	$716.98
Rate for Payer: Wellpoint Medicaid Managed Care	$788.38

PRODISC-C MOLYB 12X15X6MM

Facility

$29,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270694331
Hospital Revenue Code	278
Min. Negotiated Rate	$4,462.50
Max. Negotiated Rate	$7,199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,545.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50

PRODISC C VIVO 15X14MM H6MM

Facility

$29,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270704586
Hospital Revenue Code	278
Min. Negotiated Rate	$4,462.50
Max. Negotiated Rate	$7,199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,545.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50

PRODISC C VIVO 15X14MM H6MM

Facility

$29,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270704586
Hospital Revenue Code	278
Min. Negotiated Rate	$716.98
Max. Negotiated Rate	$14,875.00
Rate for Payer: Aetna Commercial	$11,305.00
Rate for Payer: Aetna Medicare Advantage	$8,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,586.25
Rate for Payer: Cigna Commercial	$14,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,545.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50
Rate for Payer: UnitedHealthcare Community & State	$716.98
Rate for Payer: Wellpoint Medicaid Managed Care	$788.38

PRODISC C VIVO 17X14MM H5MM

Facility

$29,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270704629
Hospital Revenue Code	278
Min. Negotiated Rate	$716.98
Max. Negotiated Rate	$14,875.00
Rate for Payer: Aetna Commercial	$11,305.00
Rate for Payer: Aetna Medicare Advantage	$8,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,586.25
Rate for Payer: Cigna Commercial	$14,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,545.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50
Rate for Payer: UnitedHealthcare Community & State	$716.98
Rate for Payer: Wellpoint Medicaid Managed Care	$788.38

PRODISC C VIVO 17X14MM H5MM

Facility

$29,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270704629
Hospital Revenue Code	278
Min. Negotiated Rate	$4,462.50
Max. Negotiated Rate	$7,199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,545.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50

Know your out-of-pocket cost for care.

All Charges