Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

*****OR 4 TO 5 HOURS

Facility

$3,890.00

Hospital Charge Code	1600055
Hospital Revenue Code	360
Min. Negotiated Rate	$583.50
Max. Negotiated Rate	$583.50
Rate for Payer: Qualcare PPO/HMO/WC	$583.50

ORAJEL

Facility

$21.00

Hospital Charge Code	60634876
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$7.98
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.30
Rate for Payer: Oxford Commercial	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$4.20
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

ORAJEL

Facility

$21.00

Hospital Charge Code	60634876
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

ORAL COLON LAVAGE 4OZ JAR

Facility

$37.80

Hospital Charge Code	60628944
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna Commercial	$14.36
Rate for Payer: Aetna Medicare Advantage	$11.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.64
Rate for Payer: Cigna Commercial	$18.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.34
Rate for Payer: Oxford Commercial	$7.56
Rate for Payer: Qualcare PPO/HMO/WC	$5.67
Rate for Payer: UnitedHealthcare Commercial	$7.56
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$1.00

ORAL COLON LAVAGE 4OZ JAR

Facility

$37.80

Hospital Charge Code	60628944
Hospital Revenue Code	250
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$5.67
Rate for Payer: Qualcare PPO/HMO/WC	$5.67

ORAL COLON LAVAGE SOL

Facility

$154.10

Service Code	NDC 52268010001
Hospital Charge Code	60628134
Hospital Revenue Code	250
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$77.05
Rate for Payer: Aetna Commercial	$58.56
Rate for Payer: Aetna Medicare Advantage	$46.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.30
Rate for Payer: Cigna Commercial	$77.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.23
Rate for Payer: Oxford Commercial	$30.82
Rate for Payer: Qualcare PPO/HMO/WC	$23.11
Rate for Payer: UnitedHealthcare Commercial	$30.82
Rate for Payer: UnitedHealthcare Community & State	$3.71
Rate for Payer: Wellpoint Medicaid Managed Care	$4.08

ORAL COLON LAVAGE SOL

Facility

$154.10

Service Code	NDC 52268010001
Hospital Charge Code	60628134
Hospital Revenue Code	250
Min. Negotiated Rate	$23.11
Max. Negotiated Rate	$23.11
Rate for Payer: Qualcare PPO/HMO/WC	$23.11

ORAL COLON LAVAGE SOL GAL

Facility

$122.90

Hospital Charge Code	6004030
Hospital Revenue Code	251
Min. Negotiated Rate	$18.43
Max. Negotiated Rate	$18.43
Rate for Payer: Qualcare PPO/HMO/WC	$18.43

ORAL COLON LAVAGE SOL GAL

Facility

$122.90

Hospital Charge Code	6004030
Hospital Revenue Code	251
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$61.45
Rate for Payer: Aetna Commercial	$46.70
Rate for Payer: Aetna Medicare Advantage	$36.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.34
Rate for Payer: Cigna Commercial	$61.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.87
Rate for Payer: Oxford Commercial	$24.58
Rate for Payer: Qualcare PPO/HMO/WC	$18.43
Rate for Payer: UnitedHealthcare Commercial	$24.58
Rate for Payer: UnitedHealthcare Community & State	$2.96
Rate for Payer: Wellpoint Medicaid Managed Care	$3.26

ORAL ELECRO MIXTURE SOL 80Z

Facility

$15.40

Hospital Charge Code	6013080
Hospital Revenue Code	251
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

ORAL ELECRO MIXTURE SOL 80Z

Facility

$15.40

Hospital Charge Code	6013080
Hospital Revenue Code	251
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$7.70
Rate for Payer: Aetna Commercial	$5.85
Rate for Payer: Aetna Medicare Advantage	$4.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.93
Rate for Payer: Cigna Commercial	$7.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.62
Rate for Payer: Oxford Commercial	$3.08
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$3.08
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

ORAL SUCTION KIT VAPREVENT

Facility

$84.06

Hospital Charge Code	270644015
Hospital Revenue Code	270
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$42.03
Rate for Payer: Aetna Commercial	$31.94
Rate for Payer: Aetna Medicare Advantage	$25.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.44
Rate for Payer: Cigna Commercial	$42.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.22
Rate for Payer: Oxford Commercial	$16.81
Rate for Payer: Qualcare PPO/HMO/WC	$12.61
Rate for Payer: UnitedHealthcare Commercial	$16.81
Rate for Payer: UnitedHealthcare Community & State	$2.03
Rate for Payer: Wellpoint Medicaid Managed Care	$2.23

ORAL SUCTION KIT VAPREVENT

Facility

$84.06

Hospital Charge Code	270644015
Hospital Revenue Code	270
Min. Negotiated Rate	$12.61
Max. Negotiated Rate	$12.61
Rate for Payer: Qualcare PPO/HMO/WC	$12.61

ORAL SWAB SUCTION SYST W/PEROX

Facility

$26.65

Hospital Charge Code	270650069
Hospital Revenue Code	270
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.00

ORAL SWAB SUCTION SYST W/PEROX

Facility

$26.65

Hospital Charge Code	270650069
Hospital Revenue Code	270
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$13.32
Rate for Payer: Aetna Commercial	$10.13
Rate for Payer: Aetna Medicare Advantage	$8.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.80
Rate for Payer: Cigna Commercial	$13.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.00
Rate for Payer: Oxford Commercial	$5.33
Rate for Payer: Qualcare PPO/HMO/WC	$4.00
Rate for Payer: UnitedHealthcare Commercial	$5.33
Rate for Payer: UnitedHealthcare Community & State	$0.64
Rate for Payer: Wellpoint Medicaid Managed Care	$0.71

OR BILAYER MATRIX WND DRSG

Facility

$10,000.00

Hospital Charge Code	1610005
Hospital Revenue Code	272
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

OR BILAYER MATRIX WND DRSG

Facility

$10,000.00

Hospital Charge Code	1610005
Hospital Revenue Code	272
Min. Negotiated Rate	$241.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,000.00
Rate for Payer: Oxford Commercial	$2,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Commercial	$2,000.00
Rate for Payer: UnitedHealthcare Community & State	$241.00
Rate for Payer: Wellpoint Medicaid Managed Care	$265.00

ORBITAL PROCEDURES WITH CC/MCC

Facility

$78,125.52

Service Code	MSDRG 113
Min. Negotiated Rate	$23,788.22
Max. Negotiated Rate	$78,125.52
Rate for Payer: Aetna Commercial	$53,938.48
Rate for Payer: Aetna Medicare Advantage	$78,125.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58,385.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58,385.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25,040.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58,385.11
Rate for Payer: Cigna Commercial	$43,998.49
Rate for Payer: Cigna Medicare Advantage	$25,040.23
Rate for Payer: Clover Medicare Advantage	$23,788.22
Rate for Payer: EmblemHealth Commercial	$75,120.69
Rate for Payer: Humana Medicare Advantage	$25,791.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25,040.23
Rate for Payer: Oxford Commercial	$31,622.29
Rate for Payer: UnitedHealthcare Commercial	$55,450.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$25,040.23
Rate for Payer: Wellcare Medicare Advantage	$25,040.23

ORBITAL PROCEDURES WITHOUT CC/MCC

Facility

$45,865.28

Service Code	MSDRG 114
Min. Negotiated Rate	$13,965.39
Max. Negotiated Rate	$45,865.28
Rate for Payer: Aetna Commercial	$31,772.01
Rate for Payer: Aetna Medicare Advantage	$45,865.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,611.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,611.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14,700.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28,611.03
Rate for Payer: Cigna Commercial	$25,320.04
Rate for Payer: Cigna Medicare Advantage	$14,700.41
Rate for Payer: Clover Medicare Advantage	$13,965.39
Rate for Payer: EmblemHealth Commercial	$44,101.23
Rate for Payer: Humana Medicare Advantage	$15,141.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14,700.41
Rate for Payer: Oxford Commercial	$18,197.85
Rate for Payer: UnitedHealthcare Commercial	$31,910.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$14,700.41
Rate for Payer: Wellcare Medicare Advantage	$14,700.41

ORBITAL RIM 7mm MTX 04.503.373

Facility

$1,548.75

Hospital Charge Code	270640448
Hospital Revenue Code	272
Min. Negotiated Rate	$37.32
Max. Negotiated Rate	$774.38
Rate for Payer: Aetna Commercial	$588.52
Rate for Payer: Aetna Medicare Advantage	$464.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$394.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$394.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$394.93
Rate for Payer: Cigna Commercial	$774.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$464.62
Rate for Payer: Oxford Commercial	$309.75
Rate for Payer: Qualcare PPO/HMO/WC	$232.31
Rate for Payer: UnitedHealthcare Commercial	$309.75
Rate for Payer: UnitedHealthcare Community & State	$37.32
Rate for Payer: Wellpoint Medicaid Managed Care	$41.04

ORBITAL RIM 7mm MTX 04.503.373

Facility

$1,548.75

Hospital Charge Code	270640448
Hospital Revenue Code	272
Min. Negotiated Rate	$232.31
Max. Negotiated Rate	$232.31
Rate for Payer: Qualcare PPO/HMO/WC	$232.31

ORBIT AND EYE PROCEDURES

Facility

$22,193.05

Service Code	APR-DRG 0733
Min. Negotiated Rate	$21,757.89
Max. Negotiated Rate	$22,193.05
Rate for Payer: UnitedHealthcare Community & State	$21,757.89
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$22,193.05
Rate for Payer: Wellpoint Medicaid Managed Care	$21,757.89

ORBIT AND EYE PROCEDURES

Facility

$40,460.21

Service Code	APR-DRG 0734
Min. Negotiated Rate	$39,666.87
Max. Negotiated Rate	$40,460.21
Rate for Payer: UnitedHealthcare Community & State	$39,666.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$40,460.21
Rate for Payer: Wellpoint Medicaid Managed Care	$39,666.87

ORBIT AND EYE PROCEDURES

Facility

$14,093.56

Service Code	APR-DRG 0732
Min. Negotiated Rate	$13,817.22
Max. Negotiated Rate	$14,093.56
Rate for Payer: UnitedHealthcare Community & State	$13,817.22
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,093.56
Rate for Payer: Wellpoint Medicaid Managed Care	$13,817.22

ORBIT AND EYE PROCEDURES

Facility

$11,461.00

Service Code	APR-DRG 0731
Min. Negotiated Rate	$11,236.27
Max. Negotiated Rate	$11,461.00
Rate for Payer: UnitedHealthcare Community & State	$11,236.27
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,461.00
Rate for Payer: Wellpoint Medicaid Managed Care	$11,236.27

Know your out-of-pocket cost for care.

All Charges