Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OBURATOR BLUNT 12 MM STAPLER

Facility

$3,900.00

Hospital Charge Code	270691092
Hospital Revenue Code	272
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

OBURATOR BLUNT 12 MM STAPLER

Facility

$3,900.00

Hospital Charge Code	270691092
Hospital Revenue Code	272
Min. Negotiated Rate	$585.00
Max. Negotiated Rate	$585.00
Rate for Payer: Qualcare PPO/HMO/WC	$585.00

OB-US<14 WEEKS, ADDL FETUS

Facility

$1,117.00

Service Code	HCPCS 76802
Hospital Charge Code	83653035
Hospital Revenue Code	402
Min. Negotiated Rate	$26.92
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$424.46
Rate for Payer: Aetna Medicare Advantage	$335.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$284.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$284.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$83.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$284.83
Rate for Payer: Cigna Commercial	$558.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$335.10
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$167.55
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$26.92
Rate for Payer: Wellpoint Medicaid Managed Care	$29.60

OB-US<14 WEEKS, ADDL FETUS

Facility

$1,117.00

Service Code	HCPCS 76802
Hospital Charge Code	83653035
Hospital Revenue Code	402
Min. Negotiated Rate	$167.55
Max. Negotiated Rate	$167.55
Rate for Payer: Qualcare PPO/HMO/WC	$167.55

OB-US>14 WEEKS, ADDL FETUS

Facility

$1,408.00

Service Code	HCPCS 76810
Hospital Charge Code	83653045
Hospital Revenue Code	402
Min. Negotiated Rate	$33.93
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$535.04
Rate for Payer: Aetna Medicare Advantage	$422.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$359.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$359.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$249.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$359.04
Rate for Payer: Cigna Commercial	$704.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$422.40
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$211.20
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$33.93
Rate for Payer: Wellpoint Medicaid Managed Care	$37.31

OB-US>14 WEEKS, ADDL FETUS

Facility

$1,408.00

Service Code	HCPCS 76810
Hospital Charge Code	83653045
Hospital Revenue Code	402
Min. Negotiated Rate	$211.20
Max. Negotiated Rate	$211.20
Rate for Payer: Qualcare PPO/HMO/WC	$211.20

OB-US<14 WKS, SINGLE FETUS

Facility

$1,563.80

Service Code	HCPCS 76801
Hospital Charge Code	83653030
Hospital Revenue Code	402
Min. Negotiated Rate	$234.57
Max. Negotiated Rate	$234.57
Rate for Payer: Qualcare PPO/HMO/WC	$234.57

OB-US<14 WKS, SINGLE FETUS

Facility

$1,563.80

Service Code	HCPCS 76801
Hospital Charge Code	83653030
Hospital Revenue Code	402
Min. Negotiated Rate	$37.69
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$106.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$469.14
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$234.57
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$37.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$41.44

OB-US LIMITED MULTIPLE FETUS

Facility

$1,117.00

Service Code	HCPCS 76815
Hospital Charge Code	74308350
Hospital Revenue Code	402
Min. Negotiated Rate	$167.55
Max. Negotiated Rate	$167.55
Rate for Payer: Qualcare PPO/HMO/WC	$167.55

OB-US LIMITED MULTIPLE FETUS

Facility

$1,117.00

Service Code	HCPCS 76815
Hospital Charge Code	74308350
Hospital Revenue Code	402
Min. Negotiated Rate	$26.92
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$67.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$335.10
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$167.55
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$26.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$29.60

OB-US LIMITED MULTIPLE FETUS

Facility

$1,117.00

Service Code	HCPCS 76815
Hospital Charge Code	83653070
Hospital Revenue Code	402
Min. Negotiated Rate	$167.55
Max. Negotiated Rate	$167.55
Rate for Payer: Qualcare PPO/HMO/WC	$167.55

OB-US LIMITED MULTIPLE FETUS

Facility

$1,117.00

Service Code	HCPCS 76815
Hospital Charge Code	83653070
Hospital Revenue Code	402
Min. Negotiated Rate	$26.92
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$67.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$335.10
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$167.55
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$26.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$29.60

OBV INP HSP HIGH SEVERITY

Facility

$666.42

Service Code	HCPCS 99236
Hospital Charge Code	87502350
Hospital Revenue Code	510
Min. Negotiated Rate	$99.96
Max. Negotiated Rate	$99.96
Rate for Payer: Qualcare PPO/HMO/WC	$99.96

OBV INP HSP HIGH SEVERITY

Facility

$666.42

Service Code	HCPCS 99236
Hospital Charge Code	87502350
Hospital Revenue Code	510
Min. Negotiated Rate	$16.06
Max. Negotiated Rate	$333.21
Rate for Payer: Aetna Commercial	$253.24
Rate for Payer: Aetna Medicare Advantage	$199.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.94
Rate for Payer: Cigna Commercial	$333.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$199.93
Rate for Payer: Qualcare PPO/HMO/WC	$99.96
Rate for Payer: UnitedHealthcare Community & State	$16.06
Rate for Payer: Wellpoint Medicaid Managed Care	$17.66

OBV INP HSP LOW SEVERITY

Facility

$412.93

Service Code	HCPCS 99234
Hospital Charge Code	87502345
Hospital Revenue Code	510
Min. Negotiated Rate	$9.95
Max. Negotiated Rate	$206.47
Rate for Payer: Aetna Commercial	$156.91
Rate for Payer: Aetna Medicare Advantage	$123.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.30
Rate for Payer: Cigna Commercial	$206.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.88
Rate for Payer: Qualcare PPO/HMO/WC	$61.94
Rate for Payer: UnitedHealthcare Community & State	$9.95
Rate for Payer: Wellpoint Medicaid Managed Care	$10.94

OBV INP HSP LOW SEVERITY

Facility

$412.93

Service Code	HCPCS 99234
Hospital Charge Code	87502345
Hospital Revenue Code	510
Min. Negotiated Rate	$61.94
Max. Negotiated Rate	$61.94
Rate for Payer: Qualcare PPO/HMO/WC	$61.94

OCA 125

Facility

$143.05

Service Code	HCPCS 86304
Hospital Charge Code	39900468
Hospital Revenue Code	302
Min. Negotiated Rate	$21.46
Max. Negotiated Rate	$21.46
Rate for Payer: Qualcare PPO/HMO/WC	$21.46

OCA 125

Facility

$143.05

Service Code	HCPCS 86304
Hospital Charge Code	39900468
Hospital Revenue Code	302
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$56.60
Rate for Payer: Aetna Medicare Advantage	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.12
Rate for Payer: Cigna Commercial	$71.53
Rate for Payer: Cigna Medicare Advantage	$20.81
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.91
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.46
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.81
Rate for Payer: Wellcare Medicare Advantage	$20.81
Rate for Payer: Wellpoint Medicaid Managed Care	$3.79

OCCLUDER DOME HOLE

Facility

$385.00

Hospital Charge Code	270669170
Hospital Revenue Code	278
Min. Negotiated Rate	$9.28
Max. Negotiated Rate	$192.50
Rate for Payer: Aetna Commercial	$146.30
Rate for Payer: Aetna Medicare Advantage	$115.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.17
Rate for Payer: Cigna Commercial	$192.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$57.75
Rate for Payer: UnitedHealthcare Community & State	$9.28
Rate for Payer: Wellpoint Medicaid Managed Care	$10.20

OCCLUDER DOME HOLE

Facility

$385.00

Hospital Charge Code	270669170
Hospital Revenue Code	278
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$93.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$57.75

OCCLUSION BALLOON CATHETER

Facility

$774.00

Hospital Charge Code	270332337
Hospital Revenue Code	278
Min. Negotiated Rate	$116.10
Max. Negotiated Rate	$187.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$154.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$170.28
Rate for Payer: Qualcare PPO/HMO/WC	$116.10

OCCLUSION BALLOON CATHETER

Facility

$774.00

Hospital Charge Code	270332337
Hospital Revenue Code	278
Min. Negotiated Rate	$18.65
Max. Negotiated Rate	$387.00
Rate for Payer: Aetna Commercial	$294.12
Rate for Payer: Aetna Medicare Advantage	$232.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$154.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.37
Rate for Payer: Cigna Commercial	$387.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$170.28
Rate for Payer: Qualcare PPO/HMO/WC	$116.10
Rate for Payer: UnitedHealthcare Community & State	$18.65
Rate for Payer: Wellpoint Medicaid Managed Care	$20.51

OCCLUSION BALLOON CATHETER

Facility

$681.00

Hospital Charge Code	270331704
Hospital Revenue Code	278
Min. Negotiated Rate	$102.15
Max. Negotiated Rate	$164.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$149.82
Rate for Payer: Qualcare PPO/HMO/WC	$102.15

OCCLUSION BALLOON CATHETER

Facility

$681.00

Hospital Charge Code	270331704
Hospital Revenue Code	278
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$340.50
Rate for Payer: Aetna Commercial	$258.78
Rate for Payer: Aetna Medicare Advantage	$204.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.66
Rate for Payer: Cigna Commercial	$340.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$149.82
Rate for Payer: Qualcare PPO/HMO/WC	$102.15
Rate for Payer: UnitedHealthcare Community & State	$16.41
Rate for Payer: Wellpoint Medicaid Managed Care	$18.05

OCCLUSIVE DEVICE IN VEIN ART

Facility

$1,564.00

Service Code	HCPCS G0269
Hospital Charge Code	4110G0269
Hospital Revenue Code	481
Min. Negotiated Rate	$37.69
Max. Negotiated Rate	$6,600.00
Rate for Payer: Aetna Commercial	$594.32
Rate for Payer: Aetna Medicare Advantage	$469.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$398.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$398.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$398.82
Rate for Payer: Cigna Commercial	$782.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$469.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$234.60
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$37.69
Rate for Payer: Wellpoint Medicaid Managed Care	$41.45

Know your out-of-pocket cost for care.

All Charges