Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OP ESTABLISHED PT VISIT LEV 5

Facility

$384.00

Service Code	HCPCS 99215
Hospital Charge Code	3401037
Hospital Revenue Code	510
Min. Negotiated Rate	$57.60
Max. Negotiated Rate	$57.60
Rate for Payer: Qualcare PPO/HMO/WC	$57.60

OPHTHALGAN OPHTH/7.5ML

Facility

$95.00

Hospital Charge Code	60633576
Hospital Revenue Code	250
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

OPHTHALGAN OPHTH/7.5ML

Facility

$95.00

Hospital Charge Code	60633576
Hospital Revenue Code	250
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$47.50
Rate for Payer: Aetna Commercial	$36.10
Rate for Payer: Aetna Medicare Advantage	$28.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.23
Rate for Payer: Cigna Commercial	$47.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.50
Rate for Payer: Oxford Commercial	$19.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.25
Rate for Payer: UnitedHealthcare Commercial	$19.00
Rate for Payer: UnitedHealthcare Community & State	$2.29
Rate for Payer: Wellpoint Medicaid Managed Care	$2.52

OPHTHALMIC IRRIGATION SOLN

Facility

$46.45

Hospital Charge Code	60628803
Hospital Revenue Code	250
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$23.23
Rate for Payer: Aetna Commercial	$17.65
Rate for Payer: Aetna Medicare Advantage	$13.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.84
Rate for Payer: Cigna Commercial	$23.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.94
Rate for Payer: Oxford Commercial	$9.29
Rate for Payer: Qualcare PPO/HMO/WC	$6.97
Rate for Payer: UnitedHealthcare Commercial	$9.29
Rate for Payer: UnitedHealthcare Community & State	$1.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1.23

OPHTHALMIC IRRIGATION SOLN

Facility

$46.45

Hospital Charge Code	60628803
Hospital Revenue Code	250
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$6.97
Rate for Payer: Qualcare PPO/HMO/WC	$6.97

OPHTHALMIC IRRIGATION, SOLN

Facility

$27.60

Service Code	NDC 10119000738
Hospital Charge Code	60628092
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$13.80
Rate for Payer: Aetna Commercial	$10.49
Rate for Payer: Aetna Medicare Advantage	$8.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.04
Rate for Payer: Cigna Commercial	$13.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.28
Rate for Payer: Oxford Commercial	$5.52
Rate for Payer: Qualcare PPO/HMO/WC	$4.14
Rate for Payer: UnitedHealthcare Commercial	$5.52
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.73

OPHTHALMIC IRRIGATION, SOLN

Facility

$27.60

Service Code	NDC 10119000738
Hospital Charge Code	60628092
Hospital Revenue Code	250
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$4.14
Rate for Payer: Qualcare PPO/HMO/WC	$4.14

OPHTHALMIC IRRIG SOL 15ML

Facility

$32.65

Hospital Charge Code	60628093
Hospital Revenue Code	250
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$16.32
Rate for Payer: Aetna Commercial	$12.41
Rate for Payer: Aetna Medicare Advantage	$9.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.33
Rate for Payer: Cigna Commercial	$16.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.79
Rate for Payer: Oxford Commercial	$6.53
Rate for Payer: Qualcare PPO/HMO/WC	$4.90
Rate for Payer: UnitedHealthcare Commercial	$6.53
Rate for Payer: UnitedHealthcare Community & State	$0.79
Rate for Payer: Wellpoint Medicaid Managed Care	$0.87

OPHTHALMIC IRRIG SOL 15ML

Facility

$32.65

Hospital Charge Code	60628093
Hospital Revenue Code	250
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$4.90
Rate for Payer: Qualcare PPO/HMO/WC	$4.90

OPHTHALMIC MEDICATION

Facility

$21.15

Hospital Charge Code	6027214
Hospital Revenue Code	251
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

OPHTHALMIC MEDICATION

Facility

$21.15

Hospital Charge Code	6027214
Hospital Revenue Code	251
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$8.04
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.34
Rate for Payer: Oxford Commercial	$4.23
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$4.23
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

OPHTHALMICS 500MG

Facility

$203.55

Hospital Charge Code	6012140
Hospital Revenue Code	251
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$101.78
Rate for Payer: Aetna Commercial	$77.35
Rate for Payer: Aetna Medicare Advantage	$61.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.91
Rate for Payer: Cigna Commercial	$101.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.06
Rate for Payer: Oxford Commercial	$40.71
Rate for Payer: Qualcare PPO/HMO/WC	$30.53
Rate for Payer: UnitedHealthcare Commercial	$40.71
Rate for Payer: UnitedHealthcare Community & State	$4.91
Rate for Payer: Wellpoint Medicaid Managed Care	$5.39

OPHTHALMICS 500MG

Facility

$203.55

Hospital Charge Code	6012140
Hospital Revenue Code	251
Min. Negotiated Rate	$30.53
Max. Negotiated Rate	$30.53
Rate for Payer: Qualcare PPO/HMO/WC	$30.53

OPHTHETIC 0.5% OPHTH/15ML

Facility

$90.00

Hospital Charge Code	60633577
Hospital Revenue Code	250
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

OPHTHETIC 0.5% OPHTH/15ML

Facility

$90.00

Hospital Charge Code	60633577
Hospital Revenue Code	250
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.00
Rate for Payer: Oxford Commercial	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Commercial	$18.00
Rate for Payer: UnitedHealthcare Community & State	$2.17
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

OPIATES 1 OR MORE

Facility

$190.45

Service Code	HCPCS 80361
Hospital Charge Code	3039030
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

OPIATES 1 OR MORE

Facility

$190.45

Service Code	HCPCS 80361
Hospital Charge Code	3039030
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$22.05
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

OPIATES 1 OR MORE

Facility

$190.45

Service Code	HCPCS 80361
Hospital Charge Code	38430030
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$22.05
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

OPIATES 1 OR MORE

Facility

$190.45

Service Code	HCPCS 80361
Hospital Charge Code	39990230
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

OPIATES 1 OR MORE

Facility

$190.45

Service Code	HCPCS 80361
Hospital Charge Code	38430030
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

OPIATES 1 OR MORE

Facility

$190.45

Service Code	HCPCS 80361
Hospital Charge Code	39990230
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$22.05
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

OPIATES, URINE

Facility

$137.79

Service Code	HCPCS 80361
Hospital Charge Code	38472502
Hospital Revenue Code	301
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$52.36
Rate for Payer: Aetna Medicare Advantage	$41.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.14
Rate for Payer: Cigna Commercial	$68.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.34
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.67
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$22.05
Rate for Payer: Wellpoint Medicaid Managed Care	$3.65

OPIATES, URINE

Facility

$137.79

Service Code	HCPCS 80361
Hospital Charge Code	38472502
Hospital Revenue Code	301
Min. Negotiated Rate	$20.67
Max. Negotiated Rate	$20.67
Rate for Payer: Qualcare PPO/HMO/WC	$20.67

OPIATES,URINE

Facility

$190.45

Service Code	HCPCS 80300
Hospital Charge Code	3006997
Hospital Revenue Code	301
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.59
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

OPIATES,URINE

Facility

$190.45

Service Code	HCPCS 80300
Hospital Charge Code	3006997
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

Know your out-of-pocket cost for care.

All Charges