Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OLIGOCLONAL BANDING

Facility

$227.00

Service Code	HCPCS 83916
Hospital Charge Code	38472678
Hospital Revenue Code	301
Min. Negotiated Rate	$34.05
Max. Negotiated Rate	$34.05
Rate for Payer: Qualcare PPO/HMO/WC	$34.05

OLIGOCLONAL BANDS,CSF

Facility

$138.20

Service Code	HCPCS 83916
Hospital Charge Code	39900113
Hospital Revenue Code	301
Min. Negotiated Rate	$3.66
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$74.50
Rate for Payer: Aetna Medicare Advantage	$88.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.87
Rate for Payer: Cigna Commercial	$69.10
Rate for Payer: Cigna Medicare Advantage	$27.39
Rate for Payer: Clover Medicare Advantage	$26.02
Rate for Payer: EmblemHealth Commercial	$82.17
Rate for Payer: Humana Medicare Advantage	$28.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$27.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.46
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.73
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$21.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.39
Rate for Payer: Wellcare Medicare Advantage	$27.39
Rate for Payer: Wellpoint Medicaid Managed Care	$3.66

OLIGOCLONAL BANDS,CSF

Facility

$138.20

Service Code	HCPCS 83916
Hospital Charge Code	39900113
Hospital Revenue Code	301
Min. Negotiated Rate	$20.73
Max. Negotiated Rate	$20.73
Rate for Payer: Qualcare PPO/HMO/WC	$20.73

OLIGOCLONAL BANDS, SERUM & CSF

Facility

$390.00

Service Code	HCPCS 83916
Hospital Charge Code	3004348
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$74.50
Rate for Payer: Aetna Medicare Advantage	$88.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.87
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$27.39
Rate for Payer: Clover Medicare Advantage	$26.02
Rate for Payer: EmblemHealth Commercial	$82.17
Rate for Payer: Humana Medicare Advantage	$28.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$27.39
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	$21.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.39
Rate for Payer: Wellcare Medicare Advantage	$27.39
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

OLIGOCLONAL BANDS, SERUM & CSF

Facility

$390.00

Service Code	HCPCS 83916
Hospital Charge Code	3004348
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

OLIVE PIN 1.4 MM

Facility

$850.00

Service Code	HCPCS C1713
Hospital Charge Code	270690335
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

OLIVE PIN 1.4 MM

Facility

$850.00

Service Code	HCPCS C1713
Hospital Charge Code	270690335
Hospital Revenue Code	278
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$20.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.52

OLIVEWIRE

Facility

$3,885.00

Hospital Charge Code	270703513
Hospital Revenue Code	278
Min. Negotiated Rate	$93.63
Max. Negotiated Rate	$1,942.50
Rate for Payer: Aetna Commercial	$1,476.30
Rate for Payer: Aetna Medicare Advantage	$1,165.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$990.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$990.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$777.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$990.67
Rate for Payer: Cigna Commercial	$1,942.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$940.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$854.70
Rate for Payer: Qualcare PPO/HMO/WC	$582.75
Rate for Payer: UnitedHealthcare Community & State	$93.63
Rate for Payer: Wellpoint Medicaid Managed Care	$102.95

OLIVEWIRE

Facility

$3,885.00

Hospital Charge Code	270703513
Hospital Revenue Code	278
Min. Negotiated Rate	$582.75
Max. Negotiated Rate	$940.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$777.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$940.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$854.70
Rate for Payer: Qualcare PPO/HMO/WC	$582.75

OLIVE WIRE 0.062

Facility

$225.00

Service Code	HCPCS C1713
Hospital Charge Code	270702089
Hospital Revenue Code	278
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$85.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$49.50
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Community & State	$5.42
Rate for Payer: Wellpoint Medicaid Managed Care	$5.96

OLIVE WIRE 0.062

Facility

$225.00

Service Code	HCPCS C1713
Hospital Charge Code	270702089
Hospital Revenue Code	278
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$54.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$49.50
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

OLIVE WIRE 15MM

Facility

$5,195.00

Hospital Charge Code	270703260
Hospital Revenue Code	279
Min. Negotiated Rate	$125.20
Max. Negotiated Rate	$2,597.50
Rate for Payer: Aetna Commercial	$1,974.10
Rate for Payer: Aetna Medicare Advantage	$1,558.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,324.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,324.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,324.72
Rate for Payer: Cigna Commercial	$2,597.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,558.50
Rate for Payer: Oxford Commercial	$1,039.00
Rate for Payer: Qualcare PPO/HMO/WC	$779.25
Rate for Payer: UnitedHealthcare Commercial	$1,039.00
Rate for Payer: UnitedHealthcare Community & State	$125.20
Rate for Payer: Wellpoint Medicaid Managed Care	$137.67

OLIVE WIRE 15MM

Facility

$5,195.00

Hospital Charge Code	270703620
Hospital Revenue Code	279
Min. Negotiated Rate	$125.20
Max. Negotiated Rate	$2,597.50
Rate for Payer: Aetna Commercial	$1,974.10
Rate for Payer: Aetna Medicare Advantage	$1,558.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,324.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,324.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,324.72
Rate for Payer: Cigna Commercial	$2,597.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,558.50
Rate for Payer: Oxford Commercial	$1,039.00
Rate for Payer: Qualcare PPO/HMO/WC	$779.25
Rate for Payer: UnitedHealthcare Commercial	$1,039.00
Rate for Payer: UnitedHealthcare Community & State	$125.20
Rate for Payer: Wellpoint Medicaid Managed Care	$137.67

OLIVE WIRE 15MM

Facility

$5,195.00

Hospital Charge Code	270703260
Hospital Revenue Code	279
Min. Negotiated Rate	$779.25
Max. Negotiated Rate	$779.25
Rate for Payer: Qualcare PPO/HMO/WC	$779.25

OLIVE WIRE 15MM

Facility

$5,195.00

Hospital Charge Code	270703620
Hospital Revenue Code	279
Min. Negotiated Rate	$779.25
Max. Negotiated Rate	$779.25
Rate for Payer: Qualcare PPO/HMO/WC	$779.25

OLIVE WIRE, 2.0X450MM

Facility

$780.50

Hospital Charge Code	270656540
Hospital Revenue Code	271
Min. Negotiated Rate	$117.08
Max. Negotiated Rate	$117.08
Rate for Payer: Qualcare PPO/HMO/WC	$117.08

OLIVE WIRE, 2.0X450MM

Facility

$780.50

Hospital Charge Code	270656540
Hospital Revenue Code	271
Min. Negotiated Rate	$18.81
Max. Negotiated Rate	$390.25
Rate for Payer: Aetna Commercial	$296.59
Rate for Payer: Aetna Medicare Advantage	$234.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$199.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$199.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$199.03
Rate for Payer: Cigna Commercial	$390.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$234.15
Rate for Payer: Oxford Commercial	$156.10
Rate for Payer: Qualcare PPO/HMO/WC	$117.08
Rate for Payer: UnitedHealthcare Commercial	$156.10
Rate for Payer: UnitedHealthcare Community & State	$18.81
Rate for Payer: Wellpoint Medicaid Managed Care	$20.68

OLOPATADINE OPTHALMIC 0.1% SOL

Facility

$1,909.50

Service Code	NDC 65027105
Hospital Charge Code	60629908
Hospital Revenue Code	250
Min. Negotiated Rate	$46.02
Max. Negotiated Rate	$954.75
Rate for Payer: Aetna Commercial	$725.61
Rate for Payer: Aetna Medicare Advantage	$572.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$486.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$486.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$486.92
Rate for Payer: Cigna Commercial	$954.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$572.85
Rate for Payer: Oxford Commercial	$381.90
Rate for Payer: Qualcare PPO/HMO/WC	$286.43
Rate for Payer: UnitedHealthcare Commercial	$381.90
Rate for Payer: UnitedHealthcare Community & State	$46.02
Rate for Payer: Wellpoint Medicaid Managed Care	$50.60

OLOPATADINE OPTHALMIC 0.1% SOL

Facility

$1,909.50

Service Code	NDC 65027105
Hospital Charge Code	60629908
Hospital Revenue Code	250
Min. Negotiated Rate	$286.43
Max. Negotiated Rate	$286.43
Rate for Payer: Qualcare PPO/HMO/WC	$286.43

OMENTECTOMY EPIPLOECTOMY

Facility

$13,267.95

Service Code	HCPCS 49255
Hospital Charge Code	1600000496
Hospital Revenue Code	360
Min. Negotiated Rate	$319.76
Max. Negotiated Rate	$27,762.46
Rate for Payer: Aetna Commercial	$20,919.71
Rate for Payer: Aetna Medicare Advantage	$24,919.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27,762.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27,762.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,691.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27,762.46
Rate for Payer: Cigna Commercial	$15,416.72
Rate for Payer: Cigna Medicare Advantage	$7,691.07
Rate for Payer: Clover Medicare Advantage	$7,306.52
Rate for Payer: EmblemHealth Commercial	$23,073.21
Rate for Payer: Humana Medicare Advantage	$7,921.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,691.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,980.39
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,990.19
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$319.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,691.07
Rate for Payer: Wellcare Medicare Advantage	$7,691.07
Rate for Payer: Wellpoint Medicaid Managed Care	$351.60

OMENTECTOMY EPIPLOECTOMY

Facility

$13,267.95

Service Code	HCPCS 49255
Hospital Charge Code	1600000496
Hospital Revenue Code	360
Min. Negotiated Rate	$1,990.19
Max. Negotiated Rate	$1,990.19
Rate for Payer: Qualcare PPO/HMO/WC	$1,990.19

OMEPRAZOLE 40 MG SR CAP

Facility

$47.25

Hospital Charge Code	60629095
Hospital Revenue Code	250
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$23.62
Rate for Payer: Aetna Commercial	$17.95
Rate for Payer: Aetna Medicare Advantage	$14.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.05
Rate for Payer: Cigna Commercial	$23.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.18
Rate for Payer: Oxford Commercial	$9.45
Rate for Payer: Qualcare PPO/HMO/WC	$7.09
Rate for Payer: UnitedHealthcare Commercial	$9.45
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

OMEPRAZOLE 40 MG SR CAP

Facility

$47.25

Hospital Charge Code	60629095
Hospital Revenue Code	250
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$7.09
Rate for Payer: Qualcare PPO/HMO/WC	$7.09

OMEPRAZOLE CAP 20MG

Facility

$34.60

Hospital Charge Code	6008858
Hospital Revenue Code	252
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

OMEPRAZOLE CAP 20MG

Facility

$34.60

Hospital Charge Code	6008858
Hospital Revenue Code	252
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$13.15
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.38
Rate for Payer: Oxford Commercial	$6.92
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$6.92
Rate for Payer: UnitedHealthcare Community & State	$0.83
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

Know your out-of-pocket cost for care.

All Charges