Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ORGANISM SENSITIVITY

Facility

$390.00

Service Code	HCPCS 87186
Hospital Charge Code	3030153
Hospital Revenue Code	309
Min. Negotiated Rate	$6.92
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$23.53
Rate for Payer: Aetna Medicare Advantage	$28.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.22
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$8.65
Rate for Payer: Clover Medicare Advantage	$8.22
Rate for Payer: EmblemHealth Commercial	$25.95
Rate for Payer: Humana Medicare Advantage	$8.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.65
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	$6.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.65
Rate for Payer: Wellcare Medicare Advantage	$8.65
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ORGANIZER LAPAROSC HUNT INST**

Facility

$30.00

Hospital Charge Code	1605641
Hospital Revenue Code	272
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

ORGANIZER LAPAROSC HUNT INST**

Facility

$30.00

Hospital Charge Code	1605641
Hospital Revenue Code	272
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna Commercial	$11.40
Rate for Payer: Aetna Medicare Advantage	$9.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.65
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.00
Rate for Payer: Oxford Commercial	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$6.00
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

ORINASE/500MG/TAB

Facility

$3.00

Hospital Charge Code	60633582
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

ORINASE/500MG/TAB

Facility

$3.00

Hospital Charge Code	60633582
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

O-RING PART 1102-3043-000

Facility

$45.75

Hospital Charge Code	270660189
Hospital Revenue Code	272
Min. Negotiated Rate	$6.86
Max. Negotiated Rate	$6.86
Rate for Payer: Qualcare PPO/HMO/WC	$6.86

O-RING PART 1102-3043-000

Facility

$45.75

Hospital Charge Code	270660189
Hospital Revenue Code	272
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$22.88
Rate for Payer: Aetna Commercial	$17.39
Rate for Payer: Aetna Medicare Advantage	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.67
Rate for Payer: Cigna Commercial	$22.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.72
Rate for Payer: Oxford Commercial	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$6.86
Rate for Payer: UnitedHealthcare Commercial	$9.15
Rate for Payer: UnitedHealthcare Community & State	$1.10
Rate for Payer: Wellpoint Medicaid Managed Care	$1.21

O'RING PREVI COLOR NOZZLE

Facility

$10.75

Hospital Charge Code	270666255
Hospital Revenue Code	270
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$1.61
Rate for Payer: Qualcare PPO/HMO/WC	$1.61

O'RING PREVI COLOR NOZZLE

Facility

$10.75

Hospital Charge Code	270666255
Hospital Revenue Code	270
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.38
Rate for Payer: Aetna Commercial	$4.08
Rate for Payer: Aetna Medicare Advantage	$3.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.74
Rate for Payer: Cigna Commercial	$5.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.23
Rate for Payer: Oxford Commercial	$2.15
Rate for Payer: Qualcare PPO/HMO/WC	$1.61
Rate for Payer: UnitedHealthcare Commercial	$2.15
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

OR INJECTION INTRA-ARTERIAL

Facility

$250.00

Service Code	HCPCS 96373
Hospital Charge Code	1600510
Hospital Revenue Code	260
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$912.17
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

OR INJECTION INTRA-ARTERIAL

Facility

$250.00

Service Code	HCPCS 96373
Hospital Charge Code	1600510
Hospital Revenue Code	260
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

ORIOS XT 10CC

Facility

$18,550.00

Service Code	HCPCS C1765
Hospital Charge Code	270704862
Hospital Revenue Code	278
Min. Negotiated Rate	$447.06
Max. Negotiated Rate	$9,275.00
Rate for Payer: Aetna Commercial	$7,049.00
Rate for Payer: Aetna Medicare Advantage	$5,565.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,730.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,730.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,710.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,730.25
Rate for Payer: Cigna Commercial	$9,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,489.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,081.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,782.50
Rate for Payer: UnitedHealthcare Community & State	$447.06
Rate for Payer: Wellpoint Medicaid Managed Care	$491.57

ORIOS XT 10CC

Facility

$18,550.00

Service Code	HCPCS C1765
Hospital Charge Code	270704862
Hospital Revenue Code	278
Min. Negotiated Rate	$2,782.50
Max. Negotiated Rate	$4,489.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,710.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,489.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,081.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,782.50

ORIOS XT 5CC

Facility

$4,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270704165
Hospital Revenue Code	278
Min. Negotiated Rate	$106.04
Max. Negotiated Rate	$2,200.00
Rate for Payer: Aetna Commercial	$1,672.00
Rate for Payer: Aetna Medicare Advantage	$1,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,122.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,122.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$880.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,122.00
Rate for Payer: Cigna Commercial	$2,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,064.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$660.00
Rate for Payer: UnitedHealthcare Community & State	$106.04
Rate for Payer: Wellpoint Medicaid Managed Care	$116.60

ORIOS XT 5CC

Facility

$4,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270704165
Hospital Revenue Code	278
Min. Negotiated Rate	$660.00
Max. Negotiated Rate	$1,064.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$880.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,064.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$660.00

ORISE Gel

Facility

$425.00

Hospital Charge Code	270688072
Hospital Revenue Code	272
Min. Negotiated Rate	$10.24
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.50
Rate for Payer: Oxford Commercial	$85.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Commercial	$85.00
Rate for Payer: UnitedHealthcare Community & State	$10.24
Rate for Payer: Wellpoint Medicaid Managed Care	$11.26

ORISE Gel

Facility

$425.00

Hospital Charge Code	270688072
Hospital Revenue Code	272
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$63.75
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

OR MAJOR 1 HOUR

Facility

$3,597.56

Hospital Charge Code	1600014
Hospital Revenue Code	360
Min. Negotiated Rate	$86.70
Max. Negotiated Rate	$1,798.78
Rate for Payer: Aetna Commercial	$1,367.07
Rate for Payer: Aetna Medicare Advantage	$1,079.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$917.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$917.38
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	$917.38
Rate for Payer: Cigna Commercial	$1,798.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,079.27
Rate for Payer: Qualcare PPO/HMO/WC	$539.63
Rate for Payer: UnitedHealthcare Community & State	$86.70
Rate for Payer: Wellpoint Medicaid Managed Care	$95.34

OR MAJOR 1 HOUR

Facility

$3,597.56

Hospital Charge Code	1600014
Hospital Revenue Code	360
Min. Negotiated Rate	$539.63
Max. Negotiated Rate	$539.63
Rate for Payer: Qualcare PPO/HMO/WC	$539.63

*****OR MAJOR 2 TO 3 HOURS

Facility

$2,204.00

Hospital Charge Code	1600030
Hospital Revenue Code	360
Min. Negotiated Rate	$53.12
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$837.52
Rate for Payer: Aetna Medicare Advantage	$661.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$562.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$562.02
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	$562.02
Rate for Payer: Cigna Commercial	$1,102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$661.20
Rate for Payer: Qualcare PPO/HMO/WC	$330.60
Rate for Payer: UnitedHealthcare Community & State	$53.12
Rate for Payer: Wellpoint Medicaid Managed Care	$58.41

*****OR MAJOR 2 TO 3 HOURS

Facility

$2,204.00

Hospital Charge Code	1600030
Hospital Revenue Code	360
Min. Negotiated Rate	$330.60
Max. Negotiated Rate	$330.60
Rate for Payer: Qualcare PPO/HMO/WC	$330.60

*****OR MAJOR 3 TO 4 HOURS

Facility

$2,868.00

Hospital Charge Code	1600048
Hospital Revenue Code	360
Min. Negotiated Rate	$69.12
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$1,089.84
Rate for Payer: Aetna Medicare Advantage	$860.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$731.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$731.34
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	$731.34
Rate for Payer: Cigna Commercial	$1,434.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$860.40
Rate for Payer: Qualcare PPO/HMO/WC	$430.20
Rate for Payer: UnitedHealthcare Community & State	$69.12
Rate for Payer: Wellpoint Medicaid Managed Care	$76.00

*****OR MAJOR 3 TO 4 HOURS

Facility

$2,868.00

Hospital Charge Code	1600048
Hospital Revenue Code	360
Min. Negotiated Rate	$430.20
Max. Negotiated Rate	$430.20
Rate for Payer: Qualcare PPO/HMO/WC	$430.20

*****OR MAJOR 5 TO 6 HOURS

Facility

$6,024.00

Hospital Charge Code	1600063
Hospital Revenue Code	360
Min. Negotiated Rate	$145.18
Max. Negotiated Rate	$3,012.00
Rate for Payer: Aetna Commercial	$2,289.12
Rate for Payer: Aetna Medicare Advantage	$1,807.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,536.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,536.12
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	$1,536.12
Rate for Payer: Cigna Commercial	$3,012.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,807.20
Rate for Payer: Qualcare PPO/HMO/WC	$903.60
Rate for Payer: UnitedHealthcare Community & State	$145.18
Rate for Payer: Wellpoint Medicaid Managed Care	$159.64

*****OR MAJOR 5 TO 6 HOURS

Facility

$6,024.00

Hospital Charge Code	1600063
Hospital Revenue Code	360
Min. Negotiated Rate	$903.60
Max. Negotiated Rate	$903.60
Rate for Payer: Qualcare PPO/HMO/WC	$903.60

Know your out-of-pocket cost for care.

All Charges