Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OR PLASTIC SURGERY HOUR CHARGE

Facility

$960.00

Hospital Charge Code	1600172
Hospital Revenue Code	360
Min. Negotiated Rate	$144.00
Max. Negotiated Rate	$144.00
Rate for Payer: Qualcare PPO/HMO/WC	$144.00

O.R. PROCEDURES FOR OBESITY WITH CC

Facility

$53,858.41

Service Code	MSDRG 620
Min. Negotiated Rate	$16,399.19
Max. Negotiated Rate	$53,858.41
Rate for Payer: Aetna Commercial	$37,264.20
Rate for Payer: Aetna Medicare Advantage	$53,858.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37,682.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37,682.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17,262.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37,682.82
Rate for Payer: Cigna Commercial	$29,948.01
Rate for Payer: Cigna Medicare Advantage	$17,262.31
Rate for Payer: Clover Medicare Advantage	$16,399.19
Rate for Payer: EmblemHealth Commercial	$51,786.93
Rate for Payer: Humana Medicare Advantage	$17,780.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17,262.31
Rate for Payer: Oxford Commercial	$21,524.03
Rate for Payer: UnitedHealthcare Commercial	$37,743.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$17,262.31
Rate for Payer: Wellcare Medicare Advantage	$17,262.31

O.R. PROCEDURES FOR OBESITY WITH MCC

Facility

$95,459.58

Service Code	MSDRG 619
Min. Negotiated Rate	$29,066.22
Max. Negotiated Rate	$95,459.58
Rate for Payer: Aetna Commercial	$65,848.94
Rate for Payer: Aetna Medicare Advantage	$95,459.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60,478.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60,478.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30,596.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60,478.60
Rate for Payer: Cigna Commercial	$54,034.80
Rate for Payer: Cigna Medicare Advantage	$30,596.02
Rate for Payer: Clover Medicare Advantage	$29,066.22
Rate for Payer: EmblemHealth Commercial	$91,788.06
Rate for Payer: Humana Medicare Advantage	$31,513.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$30,596.02
Rate for Payer: Oxford Commercial	$38,835.53
Rate for Payer: UnitedHealthcare Commercial	$68,099.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$30,596.02
Rate for Payer: Wellcare Medicare Advantage	$30,596.02

O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC

Facility

$50,888.07

Service Code	MSDRG 621
Min. Negotiated Rate	$15,494.77
Max. Negotiated Rate	$50,888.07
Rate for Payer: Aetna Commercial	$35,223.22
Rate for Payer: Aetna Medicare Advantage	$50,888.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35,356.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35,356.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16,310.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35,356.72
Rate for Payer: Cigna Commercial	$28,228.20
Rate for Payer: Cigna Medicare Advantage	$16,310.28
Rate for Payer: Clover Medicare Advantage	$15,494.77
Rate for Payer: EmblemHealth Commercial	$48,930.84
Rate for Payer: Humana Medicare Advantage	$16,799.59
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16,310.28
Rate for Payer: Oxford Commercial	$20,287.98
Rate for Payer: UnitedHealthcare Commercial	$35,575.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$16,310.28
Rate for Payer: Wellcare Medicare Advantage	$16,310.28

O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC

Facility

$77,666.53

Service Code	MSDRG 940
Min. Negotiated Rate	$23,648.46
Max. Negotiated Rate	$77,666.53
Rate for Payer: Aetna Commercial	$53,623.08
Rate for Payer: Aetna Medicare Advantage	$77,666.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50,476.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50,476.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24,893.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50,476.37
Rate for Payer: Cigna Commercial	$43,732.75
Rate for Payer: Cigna Medicare Advantage	$24,893.12
Rate for Payer: Clover Medicare Advantage	$23,648.46
Rate for Payer: EmblemHealth Commercial	$74,679.36
Rate for Payer: Humana Medicare Advantage	$25,639.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24,893.12
Rate for Payer: Oxford Commercial	$31,431.31
Rate for Payer: UnitedHealthcare Commercial	$55,115.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$24,893.12
Rate for Payer: Wellcare Medicare Advantage	$24,893.12

O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC

Facility

$119,413.20

Service Code	MSDRG 939
Min. Negotiated Rate	$36,359.79
Max. Negotiated Rate	$119,413.20
Rate for Payer: Aetna Commercial	$82,307.81
Rate for Payer: Aetna Medicare Advantage	$119,413.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74,900.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74,900.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$38,273.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74,900.42
Rate for Payer: Cigna Commercial	$67,903.75
Rate for Payer: Cigna Medicare Advantage	$38,273.46
Rate for Payer: Clover Medicare Advantage	$36,359.79
Rate for Payer: EmblemHealth Commercial	$114,820.38
Rate for Payer: Humana Medicare Advantage	$39,421.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$38,273.46
Rate for Payer: Oxford Commercial	$48,803.32
Rate for Payer: UnitedHealthcare Commercial	$85,578.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$38,273.46
Rate for Payer: Wellcare Medicare Advantage	$38,273.46

O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC

Facility

$67,672.71

Service Code	MSDRG 941
Min. Negotiated Rate	$20,605.47
Max. Negotiated Rate	$67,672.71
Rate for Payer: Aetna Commercial	$46,756.21
Rate for Payer: Aetna Medicare Advantage	$67,672.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43,265.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43,265.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,689.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43,265.46
Rate for Payer: Cigna Commercial	$37,946.38
Rate for Payer: Cigna Medicare Advantage	$21,689.97
Rate for Payer: Clover Medicare Advantage	$20,605.47
Rate for Payer: EmblemHealth Commercial	$65,069.91
Rate for Payer: Humana Medicare Advantage	$22,340.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,689.97
Rate for Payer: Oxford Commercial	$27,272.56
Rate for Payer: UnitedHealthcare Commercial	$47,823.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,689.97
Rate for Payer: Wellcare Medicare Advantage	$21,689.97

O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS

Facility

$127,054.01

Service Code	MSDRG 876
Min. Negotiated Rate	$38,686.32
Max. Negotiated Rate	$127,054.01
Rate for Payer: Aetna Commercial	$87,557.90
Rate for Payer: Aetna Medicare Advantage	$127,054.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86,763.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86,763.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$40,722.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86,763.53
Rate for Payer: Cigna Commercial	$72,327.74
Rate for Payer: Cigna Medicare Advantage	$40,722.44
Rate for Payer: Clover Medicare Advantage	$38,686.32
Rate for Payer: EmblemHealth Commercial	$122,167.32
Rate for Payer: Humana Medicare Advantage	$41,944.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$40,722.44
Rate for Payer: Oxford Commercial	$51,982.90
Rate for Payer: UnitedHealthcare Commercial	$91,153.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$40,722.44
Rate for Payer: Wellcare Medicare Advantage	$40,722.44

OR THERASKIN - PER SQ CM

Facility

$102.00

Hospital Charge Code	270646669R
Hospital Revenue Code	636
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$51.00
Rate for Payer: Aetna Commercial	$38.76
Rate for Payer: Aetna Medicare Advantage	$30.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.01
Rate for Payer: Cigna Commercial	$51.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.68
Rate for Payer: Qualcare PPO/HMO/WC	$15.30
Rate for Payer: UnitedHealthcare Community & State	$2.46
Rate for Payer: Wellpoint Medicaid Managed Care	$2.70

OR THERASKIN - PER SQ CM

Facility

$102.00

Hospital Charge Code	270646669R
Hospital Revenue Code	636
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$24.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.68
Rate for Payer: Qualcare PPO/HMO/WC	$15.30

ORTHOCORD

Facility

$245.00

Hospital Charge Code	270663293
Hospital Revenue Code	272
Min. Negotiated Rate	$5.90
Max. Negotiated Rate	$122.50
Rate for Payer: Aetna Commercial	$93.10
Rate for Payer: Aetna Medicare Advantage	$73.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.48
Rate for Payer: Cigna Commercial	$122.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.50
Rate for Payer: Oxford Commercial	$49.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.75
Rate for Payer: UnitedHealthcare Commercial	$49.00
Rate for Payer: UnitedHealthcare Community & State	$5.90
Rate for Payer: Wellpoint Medicaid Managed Care	$6.49

ORTHOCORD

Facility

$245.00

Hospital Charge Code	270663293
Hospital Revenue Code	272
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$36.75
Rate for Payer: Qualcare PPO/HMO/WC	$36.75

ORTHOCORD #2 SUTURE 223105

Facility

$1,645.00

Hospital Charge Code	270634228
Hospital Revenue Code	272
Min. Negotiated Rate	$39.64
Max. Negotiated Rate	$822.50
Rate for Payer: Aetna Commercial	$625.10
Rate for Payer: Aetna Medicare Advantage	$493.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$419.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$419.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$419.48
Rate for Payer: Cigna Commercial	$822.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$493.50
Rate for Payer: Oxford Commercial	$329.00
Rate for Payer: Qualcare PPO/HMO/WC	$246.75
Rate for Payer: UnitedHealthcare Commercial	$329.00
Rate for Payer: UnitedHealthcare Community & State	$39.64
Rate for Payer: Wellpoint Medicaid Managed Care	$43.59

ORTHOCORD #2 SUTURE 223105

Facility

$1,645.00

Hospital Charge Code	270634228
Hospital Revenue Code	272
Min. Negotiated Rate	$246.75
Max. Negotiated Rate	$246.75
Rate for Payer: Qualcare PPO/HMO/WC	$246.75

ORTHO-DIENESTROL 0.01%/78

Facility

$122.00

Hospital Charge Code	60633587
Hospital Revenue Code	250
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$18.30
Rate for Payer: Qualcare PPO/HMO/WC	$18.30

ORTHO-DIENESTROL 0.01%/78

Facility

$122.00

Hospital Charge Code	60633587
Hospital Revenue Code	250
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$61.00
Rate for Payer: Aetna Commercial	$46.36
Rate for Payer: Aetna Medicare Advantage	$36.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.11
Rate for Payer: Cigna Commercial	$61.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.60
Rate for Payer: Oxford Commercial	$24.40
Rate for Payer: Qualcare PPO/HMO/WC	$18.30
Rate for Payer: UnitedHealthcare Commercial	$24.40
Rate for Payer: UnitedHealthcare Community & State	$2.94
Rate for Payer: Wellpoint Medicaid Managed Care	$3.23

ORTHOGLASS 3X15 FOR ARM SPLINT

Facility

$167.25

Hospital Charge Code	8004160
Hospital Revenue Code	272
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$83.62
Rate for Payer: Aetna Commercial	$63.55
Rate for Payer: Aetna Medicare Advantage	$50.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.65
Rate for Payer: Cigna Commercial	$83.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.17
Rate for Payer: Oxford Commercial	$33.45
Rate for Payer: Qualcare PPO/HMO/WC	$25.09
Rate for Payer: UnitedHealthcare Commercial	$33.45
Rate for Payer: UnitedHealthcare Community & State	$4.03
Rate for Payer: Wellpoint Medicaid Managed Care	$4.43

ORTHOGLASS 3X15 FOR ARM SPLINT

Facility

$167.25

Hospital Charge Code	8004160
Hospital Revenue Code	272
Min. Negotiated Rate	$25.09
Max. Negotiated Rate	$25.09
Rate for Payer: Qualcare PPO/HMO/WC	$25.09

ORTHOGLASS 3X15 FOR LEG SPLINT

Facility

$220.85

Hospital Charge Code	8004137
Hospital Revenue Code	272
Min. Negotiated Rate	$33.13
Max. Negotiated Rate	$33.13
Rate for Payer: Qualcare PPO/HMO/WC	$33.13

ORTHOGLASS 3X15 FOR LEG SPLINT

Facility

$220.85

Hospital Charge Code	8004137
Hospital Revenue Code	272
Min. Negotiated Rate	$5.32
Max. Negotiated Rate	$110.42
Rate for Payer: Aetna Commercial	$83.92
Rate for Payer: Aetna Medicare Advantage	$66.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.32
Rate for Payer: Cigna Commercial	$110.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.25
Rate for Payer: Oxford Commercial	$44.17
Rate for Payer: Qualcare PPO/HMO/WC	$33.13
Rate for Payer: UnitedHealthcare Commercial	$44.17
Rate for Payer: UnitedHealthcare Community & State	$5.32
Rate for Payer: Wellpoint Medicaid Managed Care	$5.85

ORTHOGLASS 4X15 FOR ARM SPLINT

Facility

$198.45

Hospital Charge Code	8004152
Hospital Revenue Code	272
Min. Negotiated Rate	$29.77
Max. Negotiated Rate	$29.77
Rate for Payer: Qualcare PPO/HMO/WC	$29.77

ORTHOGLASS 4X15 FOR ARM SPLINT

Facility

$198.45

Hospital Charge Code	8004152
Hospital Revenue Code	272
Min. Negotiated Rate	$4.78
Max. Negotiated Rate	$99.22
Rate for Payer: Aetna Commercial	$75.41
Rate for Payer: Aetna Medicare Advantage	$59.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.60
Rate for Payer: Cigna Commercial	$99.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.53
Rate for Payer: Oxford Commercial	$39.69
Rate for Payer: Qualcare PPO/HMO/WC	$29.77
Rate for Payer: UnitedHealthcare Commercial	$39.69
Rate for Payer: UnitedHealthcare Community & State	$4.78
Rate for Payer: Wellpoint Medicaid Managed Care	$5.26

ORTHOGLASS 4X15 FOR LEG SPLINT

Facility

$264.85

Hospital Charge Code	8004129
Hospital Revenue Code	272
Min. Negotiated Rate	$39.73
Max. Negotiated Rate	$39.73
Rate for Payer: Qualcare PPO/HMO/WC	$39.73

ORTHOGLASS 4X15 FOR LEG SPLINT

Facility

$264.85

Hospital Charge Code	8004129
Hospital Revenue Code	272
Min. Negotiated Rate	$6.38
Max. Negotiated Rate	$132.43
Rate for Payer: Aetna Commercial	$100.64
Rate for Payer: Aetna Medicare Advantage	$79.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.54
Rate for Payer: Cigna Commercial	$132.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.45
Rate for Payer: Oxford Commercial	$52.97
Rate for Payer: Qualcare PPO/HMO/WC	$39.73
Rate for Payer: UnitedHealthcare Commercial	$52.97
Rate for Payer: UnitedHealthcare Community & State	$6.38
Rate for Payer: Wellpoint Medicaid Managed Care	$7.02

ORTHOGLASS 5X15 FOR ARM SPLINT

Facility

$246.45

Hospital Charge Code	8004145
Hospital Revenue Code	272
Min. Negotiated Rate	$36.97
Max. Negotiated Rate	$36.97
Rate for Payer: Qualcare PPO/HMO/WC	$36.97

Know your out-of-pocket cost for care.

All Charges