Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SPHINCTEROTOME-BILLROTH DOUBLE

Facility

$1,130.00

Service Code	HCPCS C1729
Hospital Charge Code	270679383
Hospital Revenue Code	278
Min. Negotiated Rate	$27.23
Max. Negotiated Rate	$565.00
Rate for Payer: Aetna Commercial	$429.40
Rate for Payer: Aetna Medicare Advantage	$339.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$288.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$288.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$226.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$288.15
Rate for Payer: Cigna Commercial	$565.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$273.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$248.60
Rate for Payer: Qualcare PPO/HMO/WC	$169.50
Rate for Payer: UnitedHealthcare Community & State	$27.23
Rate for Payer: Wellpoint Medicaid Managed Care	$29.95

SPHINCTEROTOME-BILLROTH DOUBLE

Facility

$1,130.00

Service Code	HCPCS C1729
Hospital Charge Code	270679383
Hospital Revenue Code	278
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$273.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$226.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$273.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$248.60
Rate for Payer: Qualcare PPO/HMO/WC	$169.50

SPHINCTEROTOME CELVER CUT 3 V

Facility

$1,925.00

Hospital Charge Code	270684735
Hospital Revenue Code	272
Min. Negotiated Rate	$288.75
Max. Negotiated Rate	$288.75
Rate for Payer: Qualcare PPO/HMO/WC	$288.75

SPHINCTEROTOME CELVER CUT 3 V

Facility

$1,925.00

Hospital Charge Code	270684735
Hospital Revenue Code	272
Min. Negotiated Rate	$46.39
Max. Negotiated Rate	$962.50
Rate for Payer: Aetna Commercial	$731.50
Rate for Payer: Aetna Medicare Advantage	$577.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$490.88
Rate for Payer: Cigna Commercial	$962.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$577.50
Rate for Payer: Oxford Commercial	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$288.75
Rate for Payer: UnitedHealthcare Commercial	$385.00
Rate for Payer: UnitedHealthcare Community & State	$46.39
Rate for Payer: Wellpoint Medicaid Managed Care	$51.01

SPHINCTEROTOME CK WIRE DASH480

Facility

$1,015.25

Hospital Charge Code	270622353
Hospital Revenue Code	272
Min. Negotiated Rate	$24.47
Max. Negotiated Rate	$507.62
Rate for Payer: Aetna Commercial	$385.80
Rate for Payer: Aetna Medicare Advantage	$304.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$258.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$258.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$258.89
Rate for Payer: Cigna Commercial	$507.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$304.57
Rate for Payer: Oxford Commercial	$203.05
Rate for Payer: Qualcare PPO/HMO/WC	$152.29
Rate for Payer: UnitedHealthcare Commercial	$203.05
Rate for Payer: UnitedHealthcare Community & State	$24.47
Rate for Payer: Wellpoint Medicaid Managed Care	$26.90

SPHINCTEROTOME CK WIRE DASH480

Facility

$1,015.25

Hospital Charge Code	270622353
Hospital Revenue Code	272
Min. Negotiated Rate	$152.29
Max. Negotiated Rate	$152.29
Rate for Payer: Qualcare PPO/HMO/WC	$152.29

SPHINCTEROTOME MCV 20MM 4515

Facility

$1,235.25

Hospital Charge Code	270627945
Hospital Revenue Code	272
Min. Negotiated Rate	$185.29
Max. Negotiated Rate	$185.29
Rate for Payer: Qualcare PPO/HMO/WC	$185.29

SPHINCTEROTOME MCV 20MM 4515

Facility

$1,235.25

Hospital Charge Code	270627945
Hospital Revenue Code	272
Min. Negotiated Rate	$29.77
Max. Negotiated Rate	$617.62
Rate for Payer: Aetna Commercial	$469.39
Rate for Payer: Aetna Medicare Advantage	$370.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$314.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$314.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$314.99
Rate for Payer: Cigna Commercial	$617.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$370.57
Rate for Payer: Oxford Commercial	$247.05
Rate for Payer: Qualcare PPO/HMO/WC	$185.29
Rate for Payer: UnitedHealthcare Commercial	$247.05
Rate for Payer: UnitedHealthcare Community & State	$29.77
Rate for Payer: Wellpoint Medicaid Managed Care	$32.73

SPHINCTEROTOME MCV 20MM 4517

Facility

$1,097.25

Hospital Charge Code	270630651
Hospital Revenue Code	272
Min. Negotiated Rate	$164.59
Max. Negotiated Rate	$164.59
Rate for Payer: Qualcare PPO/HMO/WC	$164.59

SPHINCTEROTOME MCV 20MM 4517

Facility

$1,097.25

Hospital Charge Code	270630651
Hospital Revenue Code	272
Min. Negotiated Rate	$26.44
Max. Negotiated Rate	$548.62
Rate for Payer: Aetna Commercial	$416.95
Rate for Payer: Aetna Medicare Advantage	$329.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$279.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$279.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$279.80
Rate for Payer: Cigna Commercial	$548.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$329.18
Rate for Payer: Oxford Commercial	$219.45
Rate for Payer: Qualcare PPO/HMO/WC	$164.59
Rate for Payer: UnitedHealthcare Commercial	$219.45
Rate for Payer: UnitedHealthcare Community & State	$26.44
Rate for Payer: Wellpoint Medicaid Managed Care	$29.08

SPHINCTEROTOME WC DASH35480

Facility

$1,002.00

Hospital Charge Code	270626897
Hospital Revenue Code	272
Min. Negotiated Rate	$24.15
Max. Negotiated Rate	$501.00
Rate for Payer: Aetna Commercial	$380.76
Rate for Payer: Aetna Medicare Advantage	$300.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.51
Rate for Payer: Cigna Commercial	$501.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.60
Rate for Payer: Oxford Commercial	$200.40
Rate for Payer: Qualcare PPO/HMO/WC	$150.30
Rate for Payer: UnitedHealthcare Commercial	$200.40
Rate for Payer: UnitedHealthcare Community & State	$24.15
Rate for Payer: Wellpoint Medicaid Managed Care	$26.55

SPHINCTEROTOME WC DASH35480

Facility

$1,002.00

Hospital Charge Code	270626897
Hospital Revenue Code	272
Min. Negotiated Rate	$150.30
Max. Negotiated Rate	$150.30
Rate for Payer: Qualcare PPO/HMO/WC	$150.30

SPHINCTEROTOME WC DB LMN CT25M

Facility

$649.60

Hospital Charge Code	270619889
Hospital Revenue Code	272
Min. Negotiated Rate	$97.44
Max. Negotiated Rate	$97.44
Rate for Payer: Qualcare PPO/HMO/WC	$97.44

SPHINCTEROTOME WC DB LMN CT25M

Facility

$649.60

Hospital Charge Code	270619889
Hospital Revenue Code	272
Min. Negotiated Rate	$15.66
Max. Negotiated Rate	$324.80
Rate for Payer: Aetna Commercial	$246.85
Rate for Payer: Aetna Medicare Advantage	$194.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.65
Rate for Payer: Cigna Commercial	$324.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$194.88
Rate for Payer: Oxford Commercial	$129.92
Rate for Payer: Qualcare PPO/HMO/WC	$97.44
Rate for Payer: UnitedHealthcare Commercial	$129.92
Rate for Payer: UnitedHealthcare Community & State	$15.66
Rate for Payer: Wellpoint Medicaid Managed Care	$17.21

SPHINCTEROTOME WC HUIBRG HPC-3

Facility

$649.60

Hospital Charge Code	270623621
Hospital Revenue Code	272
Min. Negotiated Rate	$97.44
Max. Negotiated Rate	$97.44
Rate for Payer: Qualcare PPO/HMO/WC	$97.44

SPHINCTEROTOME WC HUIBRG HPC-3

Facility

$649.60

Hospital Charge Code	270623621
Hospital Revenue Code	272
Min. Negotiated Rate	$15.66
Max. Negotiated Rate	$324.80
Rate for Payer: Aetna Commercial	$246.85
Rate for Payer: Aetna Medicare Advantage	$194.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.65
Rate for Payer: Cigna Commercial	$324.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$194.88
Rate for Payer: Oxford Commercial	$129.92
Rate for Payer: Qualcare PPO/HMO/WC	$97.44
Rate for Payer: UnitedHealthcare Commercial	$129.92
Rate for Payer: UnitedHealthcare Community & State	$15.66
Rate for Payer: Wellpoint Medicaid Managed Care	$17.21

SPHINCTEROTOMY***

Facility

$383.00

Hospital Charge Code	2300218
Hospital Revenue Code	759
Min. Negotiated Rate	$57.45
Max. Negotiated Rate	$57.45
Rate for Payer: Qualcare PPO/HMO/WC	$57.45

SPHINCTEROTOMY***

Facility

$383.00

Hospital Charge Code	2300218
Hospital Revenue Code	759
Min. Negotiated Rate	$9.23
Max. Negotiated Rate	$191.50
Rate for Payer: Aetna Commercial	$145.54
Rate for Payer: Aetna Medicare Advantage	$114.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.67
Rate for Payer: Cigna Commercial	$191.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.90
Rate for Payer: Qualcare PPO/HMO/WC	$57.45
Rate for Payer: UnitedHealthcare Community & State	$9.23
Rate for Payer: Wellpoint Medicaid Managed Care	$10.15

SPHINCTERTMY ANL DIV OF SPH

Facility

$16,685.10

Service Code	HCPCS 46080
Hospital Charge Code	1600000381
Hospital Revenue Code	360
Min. Negotiated Rate	$2,502.76
Max. Negotiated Rate	$2,502.76
Rate for Payer: Qualcare PPO/HMO/WC	$2,502.76

SPHINCTERTMY ANL DIV OF SPH

Facility

$16,685.10

Service Code	HCPCS 46080
Hospital Charge Code	1600000381
Hospital Revenue Code	360
Min. Negotiated Rate	$402.11
Max. Negotiated Rate	$11,903.20
Rate for Payer: Aetna Commercial	$8,969.36
Rate for Payer: Aetna Medicare Advantage	$10,684.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,903.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,903.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,297.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,903.20
Rate for Payer: Cigna Commercial	$6,609.93
Rate for Payer: Cigna Medicare Advantage	$3,297.56
Rate for Payer: Clover Medicare Advantage	$3,132.68
Rate for Payer: EmblemHealth Commercial	$9,892.68
Rate for Payer: Humana Medicare Advantage	$3,396.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,297.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,005.53
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,502.76
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$402.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,297.56
Rate for Payer: Wellcare Medicare Advantage	$3,297.56
Rate for Payer: Wellpoint Medicaid Managed Care	$442.16

SPHINCTER URINARY AMS800

Facility

$69,500.00

Service Code	HCPCS C1813
Hospital Charge Code	270700789
Hospital Revenue Code	278
Min. Negotiated Rate	$10,425.00
Max. Negotiated Rate	$16,819.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,819.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$15,290.00
Rate for Payer: Qualcare PPO/HMO/WC	$10,425.00

SPHINCTER URINARY AMS800

Facility

$69,500.00

Service Code	HCPCS C1813
Hospital Charge Code	270700789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,674.95
Max. Negotiated Rate	$34,750.00
Rate for Payer: Aetna Commercial	$26,410.00
Rate for Payer: Aetna Medicare Advantage	$20,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17,722.50
Rate for Payer: Cigna Commercial	$34,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,819.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$15,290.00
Rate for Payer: Qualcare PPO/HMO/WC	$10,425.00
Rate for Payer: UnitedHealthcare Community & State	$1,674.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1,841.75

SPICA THUMB MEDIUM LEFT

Facility

$71.55

Hospital Charge Code	270653979
Hospital Revenue Code	272
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$35.77
Rate for Payer: Aetna Commercial	$27.19
Rate for Payer: Aetna Medicare Advantage	$21.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.25
Rate for Payer: Cigna Commercial	$35.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.46
Rate for Payer: Oxford Commercial	$14.31
Rate for Payer: Qualcare PPO/HMO/WC	$10.73
Rate for Payer: UnitedHealthcare Commercial	$14.31
Rate for Payer: UnitedHealthcare Community & State	$1.72
Rate for Payer: Wellpoint Medicaid Managed Care	$1.90

SPICA THUMB MEDIUM LEFT

Facility

$71.55

Hospital Charge Code	270653979
Hospital Revenue Code	272
Min. Negotiated Rate	$10.73
Max. Negotiated Rate	$10.73
Rate for Payer: Qualcare PPO/HMO/WC	$10.73

SPICA THUMB SMALL LEFT

Facility

$73.65

Hospital Charge Code	270653980
Hospital Revenue Code	272
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$11.05
Rate for Payer: Qualcare PPO/HMO/WC	$11.05

Know your out-of-pocket cost for care.

All Charges