Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ORBITS COMP MIN 4VW-BI

Facility

$5,100.00

Service Code	HCPCS 7020050
Hospital Charge Code	94061205
Hospital Revenue Code	320
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

ORBITS COMP MIN 4VW-BI

Facility

$5,100.00

Service Code	HCPCS 7020050
Hospital Charge Code	94061205
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

ORBITS COMP MIN 4VW-LT

Facility

$5,100.00

Service Code	HCPCS 70200LT
Hospital Charge Code	94061261
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

ORBITS COMP MIN 4VW-LT

Facility

$5,100.00

Service Code	HCPCS 70200LT
Hospital Charge Code	94061261
Hospital Revenue Code	320
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

ORBITS COMP MIN 4VW-RT

Facility

$250.00

Service Code	HCPCS 70200RT
Hospital Charge Code	94061263
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

ORBITS COMP MIN 4VW-RT

Facility

$250.00

Service Code	HCPCS 70200RT
Hospital Charge Code	94061263
Hospital Revenue Code	320
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

OR CALL TIME

Facility

$511.25

Hospital Charge Code	1600162
Hospital Revenue Code	361
Min. Negotiated Rate	$76.69
Max. Negotiated Rate	$76.69
Rate for Payer: Qualcare PPO/HMO/WC	$76.69

OR CALL TIME

Facility

$511.25

Hospital Charge Code	1600162
Hospital Revenue Code	361
Min. Negotiated Rate	$12.32
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$194.28
Rate for Payer: Aetna Medicare Advantage	$153.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.37
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	$130.37
Rate for Payer: Cigna Commercial	$255.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.38
Rate for Payer: Qualcare PPO/HMO/WC	$76.69
Rate for Payer: UnitedHealthcare Community & State	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$13.55

ORCHIECTOMY SIMPLE BL

Facility

$25,837.00

Service Code	HCPCS 54520
Hospital Charge Code	1600000692
Hospital Revenue Code	360
Min. Negotiated Rate	$3,875.55
Max. Negotiated Rate	$3,875.55
Rate for Payer: Qualcare PPO/HMO/WC	$3,875.55

ORCHIECTOMY SIMPLE BL

Facility

$25,837.00

Service Code	HCPCS 54520
Hospital Charge Code	1600000692
Hospital Revenue Code	360
Min. Negotiated Rate	$622.67
Max. Negotiated Rate	$15,116.59
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,116.59
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,751.10
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,875.55
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$622.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$684.68

ORCHIOPEXY INGUINAL APPROACH

Facility

$30,877.00

Service Code	HCPCS 54640
Hospital Charge Code	16001002
Hospital Revenue Code	360
Min. Negotiated Rate	$4,631.55
Max. Negotiated Rate	$4,631.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,631.55

ORCHIOPEXY INGUINAL APPROACH

Facility

$30,877.00

Service Code	HCPCS 54640
Hospital Charge Code	16001002
Hospital Revenue Code	360
Min. Negotiated Rate	$744.14
Max. Negotiated Rate	$15,354.26
Rate for Payer: Aetna Commercial	$11,569.82
Rate for Payer: Aetna Medicare Advantage	$13,781.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,354.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,354.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,253.61
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	$15,354.26
Rate for Payer: Cigna Commercial	$8,526.35
Rate for Payer: Cigna Medicare Advantage	$4,253.61
Rate for Payer: Clover Medicare Advantage	$4,040.93
Rate for Payer: EmblemHealth Commercial	$12,760.83
Rate for Payer: Humana Medicare Advantage	$4,381.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,253.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,263.10
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,631.55
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$744.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,253.61
Rate for Payer: Wellcare Medicare Advantage	$4,253.61
Rate for Payer: Wellpoint Medicaid Managed Care	$818.24

ORENCIA 250MG

Facility

$2,648.00

Hospital Charge Code	60635721
Hospital Revenue Code	636
Min. Negotiated Rate	$63.82
Max. Negotiated Rate	$1,324.00
Rate for Payer: Aetna Commercial	$1,006.24
Rate for Payer: Aetna Medicare Advantage	$794.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$675.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$675.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$675.24
Rate for Payer: Cigna Commercial	$1,324.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$640.82
Rate for Payer: Qualcare PPO/HMO/WC	$397.20
Rate for Payer: UnitedHealthcare Community & State	$63.82
Rate for Payer: Wellpoint Medicaid Managed Care	$70.17

ORENCIA 250MG

Facility

$2,648.00

Hospital Charge Code	60635721
Hospital Revenue Code	636
Min. Negotiated Rate	$397.20
Max. Negotiated Rate	$640.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$640.82
Rate for Payer: Qualcare PPO/HMO/WC	$397.20

ORENCIA 250MG VIAL

Facility

$2,481.00

Hospital Charge Code	60635588
Hospital Revenue Code	636
Min. Negotiated Rate	$372.15
Max. Negotiated Rate	$600.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$600.40
Rate for Payer: Qualcare PPO/HMO/WC	$372.15

ORENCIA 250MG VIAL

Facility

$2,481.00

Hospital Charge Code	60635588
Hospital Revenue Code	636
Min. Negotiated Rate	$59.79
Max. Negotiated Rate	$1,240.50
Rate for Payer: Aetna Commercial	$942.78
Rate for Payer: Aetna Medicare Advantage	$744.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$632.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$632.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$632.65
Rate for Payer: Cigna Commercial	$1,240.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$600.40
Rate for Payer: Qualcare PPO/HMO/WC	$372.15
Rate for Payer: UnitedHealthcare Community & State	$59.79
Rate for Payer: Wellpoint Medicaid Managed Care	$65.75

Orencia(Abatacept) 250mg iv

Facility

$805.25

Hospital Charge Code	6063943273
Hospital Revenue Code	636
Min. Negotiated Rate	$19.41
Max. Negotiated Rate	$402.62
Rate for Payer: Aetna Commercial	$306.00
Rate for Payer: Aetna Medicare Advantage	$241.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$205.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$205.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$205.34
Rate for Payer: Cigna Commercial	$402.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$194.87
Rate for Payer: Qualcare PPO/HMO/WC	$120.79
Rate for Payer: UnitedHealthcare Community & State	$19.41
Rate for Payer: Wellpoint Medicaid Managed Care	$21.34

Orencia(Abatacept) 250mg iv

Facility

$805.25

Hospital Charge Code	6063943273
Hospital Revenue Code	636
Min. Negotiated Rate	$120.79
Max. Negotiated Rate	$194.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$194.87
Rate for Payer: Qualcare PPO/HMO/WC	$120.79

ORETIC/25MG/TAB

Facility

$3.00

Hospital Charge Code	60633581
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

ORETIC/25MG/TAB

Facility

$3.00

Hospital Charge Code	60633581
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

ORETIC/25MG/TAB

Facility

$4.00

Hospital Charge Code	60633580
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ORETIC/25MG/TAB

Facility

$4.00

Hospital Charge Code	60633580
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

ORGANIC ACID ANALYSIS, URINE

Facility

$80.85

Service Code	HCPCS 83919
Hospital Charge Code	3035004
Hospital Revenue Code	301
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$44.74
Rate for Payer: Aetna Medicare Advantage	$53.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.38
Rate for Payer: Cigna Commercial	$40.42
Rate for Payer: Cigna Medicare Advantage	$16.45
Rate for Payer: Clover Medicare Advantage	$15.63
Rate for Payer: EmblemHealth Commercial	$49.35
Rate for Payer: Humana Medicare Advantage	$16.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.13
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.45
Rate for Payer: Wellcare Medicare Advantage	$16.45
Rate for Payer: Wellpoint Medicaid Managed Care	$2.14

ORGANIC ACID ANALYSIS, URINE

Facility

$80.85

Service Code	HCPCS 83919
Hospital Charge Code	3035004
Hospital Revenue Code	301
Min. Negotiated Rate	$12.13
Max. Negotiated Rate	$12.13
Rate for Payer: Qualcare PPO/HMO/WC	$12.13

ORGANIC ACID FULL QUANT A

Facility

$390.00

Service Code	HCPCS 82570
Hospital Charge Code	39708015A
Hospital Revenue Code	301
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.09
Rate for Payer: Aetna Medicare Advantage	$16.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.70
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.18
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.18
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	$4.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.18
Rate for Payer: Wellcare Medicare Advantage	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

Know your out-of-pocket cost for care.

All Charges