Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH BIOPSY, SINGLE OR MULTIPLE

Facility

$8,229.07

Service Code	CPT 44361
Hospital Revenue Code	750
Min. Negotiated Rate	$315.57
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	$315.57
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

SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH CONTROL OF BLEEDING (EG, INJECTION, BIPOLAR CAUTERY, UNIPOLAR CAUTERY, LASER, HEATER PROBE, STAPLER, PLASMA COAGULATOR)

Facility

$8,229.07

Service Code	CPT 44366
Hospital Revenue Code	750
Min. Negotiated Rate	$315.57
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	$315.57
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

SMALL JOINT KIT ARTHREX

Facility

$895.00

Hospital Charge Code	270339532
Hospital Revenue Code	278
Min. Negotiated Rate	$21.57
Max. Negotiated Rate	$447.50
Rate for Payer: Aetna Commercial	$340.10
Rate for Payer: Aetna Medicare Advantage	$268.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$228.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$228.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$179.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$228.22
Rate for Payer: Cigna Commercial	$447.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$196.90
Rate for Payer: Qualcare PPO/HMO/WC	$134.25
Rate for Payer: UnitedHealthcare Community & State	$21.57
Rate for Payer: Wellpoint Medicaid Managed Care	$23.72

SMALL JOINT KIT ARTHREX

Facility

$895.00

Hospital Charge Code	270339532
Hospital Revenue Code	278
Min. Negotiated Rate	$134.25
Max. Negotiated Rate	$216.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$179.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$196.90
Rate for Payer: Qualcare PPO/HMO/WC	$134.25

SMALL JOINT KIT DISP

Facility

$725.00

Hospital Charge Code	270656577
Hospital Revenue Code	272
Min. Negotiated Rate	$108.75
Max. Negotiated Rate	$108.75
Rate for Payer: Qualcare PPO/HMO/WC	$108.75

SMALL JOINT KIT DISP

Facility

$725.00

Hospital Charge Code	270656577
Hospital Revenue Code	272
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$362.50
Rate for Payer: Aetna Commercial	$275.50
Rate for Payer: Aetna Medicare Advantage	$217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.88
Rate for Payer: Cigna Commercial	$362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.50
Rate for Payer: Oxford Commercial	$145.00
Rate for Payer: Qualcare PPO/HMO/WC	$108.75
Rate for Payer: UnitedHealthcare Commercial	$145.00
Rate for Payer: UnitedHealthcare Community & State	$17.47
Rate for Payer: Wellpoint Medicaid Managed Care	$19.21

SMALL JOINT OATS KIT 8MM

Facility

$3,900.00

Hospital Charge Code	270689468
Hospital Revenue Code	270
Min. Negotiated Rate	$93.99
Max. Negotiated Rate	$1,950.00
Rate for Payer: Aetna Commercial	$1,482.00
Rate for Payer: Aetna Medicare Advantage	$1,170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$994.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$994.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$994.50
Rate for Payer: Cigna Commercial	$1,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,170.00
Rate for Payer: Oxford Commercial	$780.00
Rate for Payer: Qualcare PPO/HMO/WC	$585.00
Rate for Payer: UnitedHealthcare Commercial	$780.00
Rate for Payer: UnitedHealthcare Community & State	$93.99
Rate for Payer: Wellpoint Medicaid Managed Care	$103.35

SMALL JOINT OATS KIT 8MM

Facility

$3,900.00

Hospital Charge Code	270689468
Hospital Revenue Code	270
Min. Negotiated Rate	$585.00
Max. Negotiated Rate	$585.00
Rate for Payer: Qualcare PPO/HMO/WC	$585.00

SMALL PLATE LARGE

Facility

$5,014.65

Service Code	HCPCS C1713
Hospital Charge Code	270693997
Hospital Revenue Code	278
Min. Negotiated Rate	$752.20
Max. Negotiated Rate	$1,213.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,002.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,213.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,103.22
Rate for Payer: Qualcare PPO/HMO/WC	$752.20

SMALL PLATE LARGE

Facility

$5,014.65

Service Code	HCPCS C1713
Hospital Charge Code	270693997
Hospital Revenue Code	278
Min. Negotiated Rate	$120.85
Max. Negotiated Rate	$2,507.32
Rate for Payer: Aetna Commercial	$1,905.57
Rate for Payer: Aetna Medicare Advantage	$1,504.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,278.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,278.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,002.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,278.74
Rate for Payer: Cigna Commercial	$2,507.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,213.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,103.22
Rate for Payer: Qualcare PPO/HMO/WC	$752.20
Rate for Payer: UnitedHealthcare Community & State	$120.85
Rate for Payer: Wellpoint Medicaid Managed Care	$132.89

Small shelve with three divide

Facility

$1,875.00

Hospital Charge Code	270665974
Hospital Revenue Code	270
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: Oxford Commercial	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$281.25
Rate for Payer: UnitedHealthcare Commercial	$375.00
Rate for Payer: UnitedHealthcare Community & State	$45.19
Rate for Payer: Wellpoint Medicaid Managed Care	$49.69

Small shelve with three divide

Facility

$1,875.00

Hospital Charge Code	270665974
Hospital Revenue Code	270
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$281.25
Rate for Payer: Qualcare PPO/HMO/WC	$281.25

SMALL X PLATE 2.4MM

Facility

$3,579.25

Service Code	HCPCS C1713
Hospital Charge Code	270705985
Hospital Revenue Code	278
Min. Negotiated Rate	$86.26
Max. Negotiated Rate	$1,789.62
Rate for Payer: Aetna Commercial	$1,360.12
Rate for Payer: Aetna Medicare Advantage	$1,073.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$912.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$912.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$715.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$912.71
Rate for Payer: Cigna Commercial	$1,789.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$866.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$787.43
Rate for Payer: Qualcare PPO/HMO/WC	$536.89
Rate for Payer: UnitedHealthcare Community & State	$86.26
Rate for Payer: Wellpoint Medicaid Managed Care	$94.85

SMALL X PLATE 2.4MM

Facility

$3,579.25

Service Code	HCPCS C1713
Hospital Charge Code	270705985
Hospital Revenue Code	278
Min. Negotiated Rate	$536.89
Max. Negotiated Rate	$866.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$715.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$866.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$787.43
Rate for Payer: Qualcare PPO/HMO/WC	$536.89

SM AND SM/RNP AB I

Facility

$390.00

Service Code	HCPCS 8623591
Hospital Charge Code	39990080A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SM AND SM/RNP AB I

Facility

$390.00

Service Code	HCPCS 8623591
Hospital Charge Code	39990080A
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

SM AND SM/RNP AB II

Facility

$390.00

Service Code	HCPCS 8623591
Hospital Charge Code	39990080B
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

SM AND SM/RNP AB II

Facility

$390.00

Service Code	HCPCS 8623591
Hospital Charge Code	39990080B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SMARTLOCK HMMF PLATE

Facility

$1,653.80

Service Code	HCPCS C1713
Hospital Charge Code	270705878
Hospital Revenue Code	278
Min. Negotiated Rate	$39.86
Max. Negotiated Rate	$826.90
Rate for Payer: Aetna Commercial	$628.44
Rate for Payer: Aetna Medicare Advantage	$496.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$421.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$421.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$330.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$421.72
Rate for Payer: Cigna Commercial	$826.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$400.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$363.84
Rate for Payer: Qualcare PPO/HMO/WC	$248.07
Rate for Payer: UnitedHealthcare Community & State	$39.86
Rate for Payer: Wellpoint Medicaid Managed Care	$43.83

SMARTLOCK HMMF PLATE

Facility

$1,653.80

Service Code	HCPCS C1713
Hospital Charge Code	270705878
Hospital Revenue Code	278
Min. Negotiated Rate	$248.07
Max. Negotiated Rate	$400.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$330.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$400.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$363.84
Rate for Payer: Qualcare PPO/HMO/WC	$248.07

SMART PORT CT TI 8FRX66CM CATH

Facility

$1,705.00

Service Code	HCPCS C1788
Hospital Charge Code	270698053
Hospital Revenue Code	278
Min. Negotiated Rate	$255.75
Max. Negotiated Rate	$412.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$341.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$412.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$375.10
Rate for Payer: Qualcare PPO/HMO/WC	$255.75

SMART PORT CT TI 8FRX66CM CATH

Facility

$1,705.00

Service Code	HCPCS C1788
Hospital Charge Code	270698053
Hospital Revenue Code	278
Min. Negotiated Rate	$41.09
Max. Negotiated Rate	$852.50
Rate for Payer: Aetna Commercial	$647.90
Rate for Payer: Aetna Medicare Advantage	$511.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$434.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$434.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$341.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$434.77
Rate for Payer: Cigna Commercial	$852.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$412.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$375.10
Rate for Payer: Qualcare PPO/HMO/WC	$255.75
Rate for Payer: UnitedHealthcare Community & State	$41.09
Rate for Payer: Wellpoint Medicaid Managed Care	$45.18

SM DISP BAYONET 18CMX1.5MM TIP

Facility

$10,980.00

Hospital Charge Code	270692098
Hospital Revenue Code	272
Min. Negotiated Rate	$264.62
Max. Negotiated Rate	$5,490.00
Rate for Payer: Aetna Commercial	$4,172.40
Rate for Payer: Aetna Medicare Advantage	$3,294.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,799.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,799.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,799.90
Rate for Payer: Cigna Commercial	$5,490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,294.00
Rate for Payer: Oxford Commercial	$2,196.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,647.00
Rate for Payer: UnitedHealthcare Commercial	$2,196.00
Rate for Payer: UnitedHealthcare Community & State	$264.62
Rate for Payer: Wellpoint Medicaid Managed Care	$290.97

SM DISP BAYONET 18CMX1.5MM TIP

Facility

$10,980.00

Hospital Charge Code	270692098
Hospital Revenue Code	272
Min. Negotiated Rate	$1,647.00
Max. Negotiated Rate	$1,647.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,647.00

SME 14 FMT STD

Facility

$15,945.85

Hospital Charge Code	270657118
Hospital Revenue Code	278
Min. Negotiated Rate	$2,391.88
Max. Negotiated Rate	$3,858.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,189.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,858.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,508.09
Rate for Payer: Qualcare PPO/HMO/WC	$2,391.88

Know your out-of-pocket cost for care.

All Charges