Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OCCLUSIVE DEVICE IN VEIN ART

Facility

$1,564.00

Service Code	HCPCS G0269
Hospital Charge Code	4110G0269
Hospital Revenue Code	481
Min. Negotiated Rate	$234.60
Max. Negotiated Rate	$234.60
Rate for Payer: Qualcare PPO/HMO/WC	$234.60

OCCULAR OCCLUDERS

Facility

$44.00

Hospital Charge Code	270335277
Hospital Revenue Code	272
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

OCCULAR OCCLUDERS

Facility

$44.00

Hospital Charge Code	270335277
Hospital Revenue Code	272
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$22.00
Rate for Payer: Aetna Commercial	$16.72
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.20
Rate for Payer: Oxford Commercial	$8.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$8.80
Rate for Payer: UnitedHealthcare Community & State	$1.06
Rate for Payer: Wellpoint Medicaid Managed Care	$1.17

OCCULT BLOOD

Facility

$121.00

Service Code	HCPCS 82270
Hospital Charge Code	38475023
Hospital Revenue Code	301
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$11.91
Rate for Payer: Aetna Medicare Advantage	$14.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.81
Rate for Payer: Cigna Commercial	$60.50
Rate for Payer: Cigna Medicare Advantage	$4.38
Rate for Payer: Clover Medicare Advantage	$4.16
Rate for Payer: EmblemHealth Commercial	$13.14
Rate for Payer: Humana Medicare Advantage	$4.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.38
Rate for Payer: Wellcare Medicare Advantage	$4.38
Rate for Payer: Wellpoint Medicaid Managed Care	$3.21

OCCULT BLOOD

Facility

$121.00

Service Code	HCPCS 82270
Hospital Charge Code	38475023
Hospital Revenue Code	301
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$18.15

OCCULT BLOOD, STOOL DIAGNOSTIC

Facility

$41.25

Service Code	HCPCS 82270
Hospital Charge Code	3002987
Hospital Revenue Code	301
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$11.91
Rate for Payer: Aetna Medicare Advantage	$14.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.81
Rate for Payer: Cigna Commercial	$20.62
Rate for Payer: Cigna Medicare Advantage	$4.38
Rate for Payer: Clover Medicare Advantage	$4.16
Rate for Payer: EmblemHealth Commercial	$13.14
Rate for Payer: Humana Medicare Advantage	$4.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.19
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.38
Rate for Payer: Wellcare Medicare Advantage	$4.38
Rate for Payer: Wellpoint Medicaid Managed Care	$1.09

OCCULT BLOOD, STOOL DIAGNOSTIC

Facility

$41.25

Service Code	HCPCS 82270
Hospital Charge Code	3002987
Hospital Revenue Code	301
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$6.19
Rate for Payer: Qualcare PPO/HMO/WC	$6.19

OCCULT BLOOD, STOOL SCREENING

Facility

$269.60

Service Code	HCPCS G0328
Hospital Charge Code	3002988
Hospital Revenue Code	305
Min. Negotiated Rate	$40.44
Max. Negotiated Rate	$40.44
Rate for Payer: Qualcare PPO/HMO/WC	$40.44

OCCULT BLOOD, STOOL SCREENING

Facility

$269.60

Service Code	HCPCS G0328
Hospital Charge Code	3002988
Hospital Revenue Code	305
Min. Negotiated Rate	$7.14
Max. Negotiated Rate	$134.80
Rate for Payer: Aetna Commercial	$49.10
Rate for Payer: Aetna Medicare Advantage	$58.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.16
Rate for Payer: Cigna Commercial	$134.80
Rate for Payer: Cigna Medicare Advantage	$18.05
Rate for Payer: Clover Medicare Advantage	$17.15
Rate for Payer: EmblemHealth Commercial	$54.15
Rate for Payer: Humana Medicare Advantage	$18.59
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.88
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.44
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.05
Rate for Payer: Wellcare Medicare Advantage	$18.05
Rate for Payer: Wellpoint Medicaid Managed Care	$7.14

OCCULT BLOOD VOMITUS

Facility

$390.00

Service Code	HCPCS 82270
Hospital Charge Code	3002989
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

OCCULT BLOOD VOMITUS

Facility

$390.00

Service Code	HCPCS 82270
Hospital Charge Code	3002989
Hospital Revenue Code	301
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$11.91
Rate for Payer: Aetna Medicare Advantage	$14.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.81
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$4.38
Rate for Payer: Clover Medicare Advantage	$4.16
Rate for Payer: EmblemHealth Commercial	$13.14
Rate for Payer: Humana Medicare Advantage	$4.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.38
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	$3.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.38
Rate for Payer: Wellcare Medicare Advantage	$4.38
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

OC DRILL

Facility

$2,375.00

Hospital Charge Code	270663781
Hospital Revenue Code	272
Min. Negotiated Rate	$57.24
Max. Negotiated Rate	$1,187.50
Rate for Payer: Aetna Commercial	$902.50
Rate for Payer: Aetna Medicare Advantage	$712.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$605.62
Rate for Payer: Cigna Commercial	$1,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$712.50
Rate for Payer: Oxford Commercial	$475.00
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Commercial	$475.00
Rate for Payer: UnitedHealthcare Community & State	$57.24
Rate for Payer: Wellpoint Medicaid Managed Care	$62.94

OC DRILL

Facility

$2,375.00

Hospital Charge Code	270663781
Hospital Revenue Code	272
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$356.25
Rate for Payer: Qualcare PPO/HMO/WC	$356.25

OC SET SCREWS

Facility

$665.00

Service Code	HCPCS C1713
Hospital Charge Code	270687818
Hospital Revenue Code	278
Min. Negotiated Rate	$16.03
Max. Negotiated Rate	$332.50
Rate for Payer: Aetna Commercial	$252.70
Rate for Payer: Aetna Medicare Advantage	$199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$133.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.57
Rate for Payer: Cigna Commercial	$332.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$146.30
Rate for Payer: Qualcare PPO/HMO/WC	$99.75
Rate for Payer: UnitedHealthcare Community & State	$16.03
Rate for Payer: Wellpoint Medicaid Managed Care	$17.62

OC SET SCREWS

Facility

$665.00

Service Code	HCPCS C1713
Hospital Charge Code	270687818
Hospital Revenue Code	278
Min. Negotiated Rate	$99.75
Max. Negotiated Rate	$160.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$133.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$146.30
Rate for Payer: Qualcare PPO/HMO/WC	$99.75

OCTAGAM 10% 20GM/200ML

Facility

$10,004.78

Service Code	HCPCS J1568
Hospital Charge Code	606390174
Hospital Revenue Code	636
Min. Negotiated Rate	$1,500.72
Max. Negotiated Rate	$2,421.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,421.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.72

OCTAGAM 10% 20GM/200ML

Facility

$10,004.78

Service Code	HCPCS J1568
Hospital Charge Code	606390174
Hospital Revenue Code	636
Min. Negotiated Rate	$44.69
Max. Negotiated Rate	$2,421.16
Rate for Payer: Aetna Commercial	$127.95
Rate for Payer: Aetna Medicare Advantage	$152.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$47.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.80
Rate for Payer: Cigna Medicare Advantage	$47.04
Rate for Payer: Clover Medicare Advantage	$44.69
Rate for Payer: EmblemHealth Commercial	$141.12
Rate for Payer: Humana Medicare Advantage	$48.45
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$47.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,421.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.72
Rate for Payer: UnitedHealthcare Community & State	$241.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$47.04
Rate for Payer: Wellcare Medicare Advantage	$47.04
Rate for Payer: Wellpoint Medicaid Managed Care	$265.13

OCTAGAM 2.5GM 5%/50ML

Facility

$3,471.27

Service Code	HCPCS J1568JW
Hospital Charge Code	606390486
Hospital Revenue Code	636
Min. Negotiated Rate	$520.69
Max. Negotiated Rate	$840.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.05
Rate for Payer: Qualcare PPO/HMO/WC	$520.69

OCTAGAM 2.5GM 5%/50ML

Facility

$3,471.27

Service Code	HCPCS J1568JW
Hospital Charge Code	606390486
Hospital Revenue Code	636
Min. Negotiated Rate	$83.66
Max. Negotiated Rate	$1,735.63
Rate for Payer: Aetna Commercial	$1,319.08
Rate for Payer: Aetna Medicare Advantage	$1,041.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$885.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$885.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$885.17
Rate for Payer: Cigna Commercial	$1,735.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.05
Rate for Payer: Qualcare PPO/HMO/WC	$520.69
Rate for Payer: UnitedHealthcare Community & State	$83.66
Rate for Payer: Wellpoint Medicaid Managed Care	$91.99

OCTAGAM 5% 5GM/100ML

Facility

$4,755.66

Service Code	HCPCS J1568
Hospital Charge Code	60628294
Hospital Revenue Code	636
Min. Negotiated Rate	$44.69
Max. Negotiated Rate	$1,150.87
Rate for Payer: Aetna Commercial	$127.95
Rate for Payer: Aetna Medicare Advantage	$152.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$47.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.80
Rate for Payer: Cigna Medicare Advantage	$47.04
Rate for Payer: Clover Medicare Advantage	$44.69
Rate for Payer: EmblemHealth Commercial	$141.12
Rate for Payer: Humana Medicare Advantage	$48.45
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$47.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,150.87
Rate for Payer: Qualcare PPO/HMO/WC	$713.35
Rate for Payer: UnitedHealthcare Community & State	$114.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$47.04
Rate for Payer: Wellcare Medicare Advantage	$47.04
Rate for Payer: Wellpoint Medicaid Managed Care	$126.02

OCTAGAM 5% 5GM/100ML

Facility

$4,755.66

Service Code	HCPCS J1568
Hospital Charge Code	60628294
Hospital Revenue Code	636
Min. Negotiated Rate	$713.35
Max. Negotiated Rate	$1,150.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,150.87
Rate for Payer: Qualcare PPO/HMO/WC	$713.35

OC TAP

Facility

$2,700.00

Hospital Charge Code	270683739
Hospital Revenue Code	272
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

OC TAP

Facility

$2,700.00

Hospital Charge Code	270683739
Hospital Revenue Code	272
Min. Negotiated Rate	$65.07
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$1,026.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$810.00
Rate for Payer: Oxford Commercial	$540.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$540.00
Rate for Payer: UnitedHealthcare Community & State	$65.07
Rate for Payer: Wellpoint Medicaid Managed Care	$71.55

OCTREASCAN (TROPOLONE) IN-111

Facility

$10,344.40

Hospital Charge Code	270658216
Hospital Revenue Code	272
Min. Negotiated Rate	$249.30
Max. Negotiated Rate	$5,172.20
Rate for Payer: Aetna Commercial	$3,930.87
Rate for Payer: Aetna Medicare Advantage	$3,103.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,637.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,637.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,637.82
Rate for Payer: Cigna Commercial	$5,172.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,103.32
Rate for Payer: Oxford Commercial	$2,068.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,551.66
Rate for Payer: UnitedHealthcare Commercial	$2,068.88
Rate for Payer: UnitedHealthcare Community & State	$249.30
Rate for Payer: Wellpoint Medicaid Managed Care	$274.13

OCTREASCAN (TROPOLONE) IN-111

Facility

$10,344.40

Hospital Charge Code	270658216
Hospital Revenue Code	272
Min. Negotiated Rate	$1,551.66
Max. Negotiated Rate	$1,551.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,551.66

Know your out-of-pocket cost for care.

All Charges