Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ORGANIC ACID FULL QUANT A

Facility

$390.00

Service Code	HCPCS 82570
Hospital Charge Code	39708015A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ORGANIC ACID FULL QUANT B

Facility

$390.00

Service Code	HCPCS 83918
Hospital Charge Code	39708015B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ORGANIC ACID FULL QUANT B

Facility

$390.00

Service Code	HCPCS 83918
Hospital Charge Code	39708015B
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$64.19
Rate for Payer: Aetna Medicare Advantage	$76.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.19
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$23.60
Rate for Payer: Clover Medicare Advantage	$22.42
Rate for Payer: EmblemHealth Commercial	$70.80
Rate for Payer: Humana Medicare Advantage	$24.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$23.60
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	$18.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.60
Rate for Payer: Wellcare Medicare Advantage	$23.60
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ORGANIC ACID QUAL EA SPEC

Facility

$390.00

Service Code	HCPCS 83919
Hospital Charge Code	39708052A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ORGANIC ACID QUAL EA SPEC

Facility

$390.00

Service Code	HCPCS 83919
Hospital Charge Code	39708052A
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
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	$195.00
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	$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	$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	$10.34

ORGANIC ACID SINGLE QUANT

Facility

$116.54

Service Code	HCPCS 83921
Hospital Charge Code	38477138
Hospital Revenue Code	301
Min. Negotiated Rate	$17.48
Max. Negotiated Rate	$17.48
Rate for Payer: Qualcare PPO/HMO/WC	$17.48

ORGANIC ACID SINGLE QUANT

Facility

$116.54

Service Code	HCPCS 83921
Hospital Charge Code	38477138
Hospital Revenue Code	301
Min. Negotiated Rate	$3.09
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$57.69
Rate for Payer: Aetna Medicare Advantage	$68.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.21
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	$76.56
Rate for Payer: Cigna Commercial	$58.27
Rate for Payer: Cigna Medicare Advantage	$21.21
Rate for Payer: Clover Medicare Advantage	$20.15
Rate for Payer: EmblemHealth Commercial	$63.63
Rate for Payer: Humana Medicare Advantage	$21.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.96
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.48
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.21
Rate for Payer: Wellcare Medicare Advantage	$21.21
Rate for Payer: Wellpoint Medicaid Managed Care	$3.09

ORGANIC ACIDS QUAL

Facility

$333.00

Service Code	HCPCS 83918
Hospital Charge Code	38472928
Hospital Revenue Code	301
Min. Negotiated Rate	$8.82
Max. Negotiated Rate	$166.50
Rate for Payer: Aetna Commercial	$64.19
Rate for Payer: Aetna Medicare Advantage	$76.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.19
Rate for Payer: Cigna Commercial	$166.50
Rate for Payer: Cigna Medicare Advantage	$23.60
Rate for Payer: Clover Medicare Advantage	$22.42
Rate for Payer: EmblemHealth Commercial	$70.80
Rate for Payer: Humana Medicare Advantage	$24.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$23.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.60
Rate for Payer: Wellcare Medicare Advantage	$23.60
Rate for Payer: Wellpoint Medicaid Managed Care	$8.82

ORGANIC ACIDS QUAL

Facility

$333.00

Service Code	HCPCS 83918
Hospital Charge Code	38472928
Hospital Revenue Code	301
Min. Negotiated Rate	$49.95
Max. Negotiated Rate	$49.95
Rate for Payer: Qualcare PPO/HMO/WC	$49.95

ORGANIC ACIDS QUAL,EACH

Facility

$116.54

Service Code	HCPCS 83919
Hospital Charge Code	38477137
Hospital Revenue Code	301
Min. Negotiated Rate	$3.09
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	$58.27
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	$34.96
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.48
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	$3.09

ORGANIC ACIDS QUAL,EACH

Facility

$116.54

Service Code	HCPCS 83919
Hospital Charge Code	38477137
Hospital Revenue Code	301
Min. Negotiated Rate	$17.48
Max. Negotiated Rate	$17.48
Rate for Payer: Qualcare PPO/HMO/WC	$17.48

ORGANIC ACID, URINE***

Facility

$260.00

Service Code	HCPCS 82486
Hospital Charge Code	3032513
Hospital Revenue Code	301
Min. Negotiated Rate	$6.27
Max. Negotiated Rate	$130.00
Rate for Payer: Aetna Commercial	$98.80
Rate for Payer: Aetna Medicare Advantage	$78.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.30
Rate for Payer: Cigna Commercial	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.27
Rate for Payer: Wellpoint Medicaid Managed Care	$6.89

ORGANIC ACID, URINE***

Facility

$260.00

Service Code	HCPCS 82486
Hospital Charge Code	3032513
Hospital Revenue Code	301
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00

ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY

Facility

$54,136.43

Service Code	MSDRG 884
Min. Negotiated Rate	$3,330.00
Max. Negotiated Rate	$54,136.43
Rate for Payer: Aetna Commercial	$37,455.24
Rate for Payer: Aetna Medicare Advantage	$54,136.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40,939.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,606.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40,939.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17,351.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40,939.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,606.00
Rate for Payer: Cigna Commercial	$30,108.95
Rate for Payer: Cigna Medicare Advantage	$17,351.42
Rate for Payer: Clover Medicare Advantage	$16,483.85
Rate for Payer: EmblemHealth Commercial	$52,054.26
Rate for Payer: Humana Medicare Advantage	$17,871.96
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17,351.42
Rate for Payer: Oxford Commercial	$21,639.71
Rate for Payer: UnitedHealthcare Commercial	$37,945.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$17,351.42
Rate for Payer: Wellcare Medicare Advantage	$17,351.42

ORGANIC MENTAL HEALTH CONDITIONS AND DISTURBANCES

Facility

$12,325.35

Service Code	APR-DRG 7573
Min. Negotiated Rate	$12,083.68
Max. Negotiated Rate	$12,325.35
Rate for Payer: UnitedHealthcare Community & State	$12,083.68
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$12,325.35
Rate for Payer: Wellpoint Medicaid Managed Care	$12,083.68

ORGANIC MENTAL HEALTH CONDITIONS AND DISTURBANCES

Facility

$5,826.92

Service Code	APR-DRG 7571
Min. Negotiated Rate	$5,712.67
Max. Negotiated Rate	$5,826.92
Rate for Payer: UnitedHealthcare Community & State	$5,712.67
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,826.92
Rate for Payer: Wellpoint Medicaid Managed Care	$5,712.67

ORGANIC MENTAL HEALTH CONDITIONS AND DISTURBANCES

Facility

$24,549.85

Service Code	APR-DRG 7574
Min. Negotiated Rate	$24,068.48
Max. Negotiated Rate	$24,549.85
Rate for Payer: UnitedHealthcare Community & State	$24,068.48
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,549.85
Rate for Payer: Wellpoint Medicaid Managed Care	$24,068.48

ORGANIC MENTAL HEALTH CONDITIONS AND DISTURBANCES

Facility

$7,692.16

Service Code	APR-DRG 7572
Min. Negotiated Rate	$7,541.33
Max. Negotiated Rate	$7,692.16
Rate for Payer: UnitedHealthcare Community & State	$7,541.33
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,692.16
Rate for Payer: Wellpoint Medicaid Managed Care	$7,541.33

ORGANIDIN/TAB

Facility

$3.00

Hospital Charge Code	60634232
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

ORGANIDIN/TAB

Facility

$3.00

Hospital Charge Code	60634232
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

ORGANISM IDENTIFICATION

Facility

$389.24

Service Code	HCPCS 87077
Hospital Charge Code	3030154
Hospital Revenue Code	309
Min. Negotiated Rate	$58.39
Max. Negotiated Rate	$58.39
Rate for Payer: Qualcare PPO/HMO/WC	$58.39

ORGANISM IDENTIFICATION

Facility

$389.24

Service Code	HCPCS 87077
Hospital Charge Code	3030154
Hospital Revenue Code	309
Min. Negotiated Rate	$6.46
Max. Negotiated Rate	$194.62
Rate for Payer: Aetna Commercial	$21.98
Rate for Payer: Aetna Medicare Advantage	$26.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.17
Rate for Payer: Cigna Commercial	$194.62
Rate for Payer: Cigna Medicare Advantage	$8.08
Rate for Payer: Clover Medicare Advantage	$7.68
Rate for Payer: EmblemHealth Commercial	$24.24
Rate for Payer: Humana Medicare Advantage	$8.32
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.39
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.08
Rate for Payer: Wellcare Medicare Advantage	$8.08
Rate for Payer: Wellpoint Medicaid Managed Care	$10.31

Organism Identification, Yeast

Facility

$70.95

Service Code	HCPCS 87106
Hospital Charge Code	399888014
Hospital Revenue Code	309
Min. Negotiated Rate	$10.64
Max. Negotiated Rate	$10.64
Rate for Payer: Qualcare PPO/HMO/WC	$10.64

Organism Identification, Yeast

Facility

$70.95

Service Code	HCPCS 87106
Hospital Charge Code	399888014
Hospital Revenue Code	309
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$28.07
Rate for Payer: Aetna Medicare Advantage	$33.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.25
Rate for Payer: Cigna Commercial	$35.48
Rate for Payer: Cigna Medicare Advantage	$10.32
Rate for Payer: Clover Medicare Advantage	$9.80
Rate for Payer: EmblemHealth Commercial	$30.96
Rate for Payer: Humana Medicare Advantage	$10.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.29
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.64
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.32
Rate for Payer: Wellcare Medicare Advantage	$10.32
Rate for Payer: Wellpoint Medicaid Managed Care	$1.88

ORGANISM SENSITIVITY

Facility

$390.00

Service Code	HCPCS 87186
Hospital Charge Code	3030153
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges