Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OMEPRAZOLE CAP SR 10MG

Facility

$26.45

Hospital Charge Code	60628171
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$13.22
Rate for Payer: Aetna Commercial	$10.05
Rate for Payer: Aetna Medicare Advantage	$7.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.74
Rate for Payer: Cigna Commercial	$13.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.93
Rate for Payer: Oxford Commercial	$5.29
Rate for Payer: Qualcare PPO/HMO/WC	$3.97
Rate for Payer: UnitedHealthcare Commercial	$5.29
Rate for Payer: UnitedHealthcare Community & State	$0.64
Rate for Payer: Wellpoint Medicaid Managed Care	$0.70

OMEPRAZOLE CAP SR 10MG

Facility

$26.45

Hospital Charge Code	60628171
Hospital Revenue Code	250
Min. Negotiated Rate	$3.97
Max. Negotiated Rate	$3.97
Rate for Payer: Qualcare PPO/HMO/WC	$3.97

OMEPRAZOLE CAP SR 20MG

Facility

$29.65

Hospital Charge Code	60628172
Hospital Revenue Code	250
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$4.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.45

OMEPRAZOLE CAP SR 20MG

Facility

$29.65

Hospital Charge Code	60628172
Hospital Revenue Code	250
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$14.82
Rate for Payer: Aetna Commercial	$11.27
Rate for Payer: Aetna Medicare Advantage	$8.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.56
Rate for Payer: Cigna Commercial	$14.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.89
Rate for Payer: Oxford Commercial	$5.93
Rate for Payer: Qualcare PPO/HMO/WC	$4.45
Rate for Payer: UnitedHealthcare Commercial	$5.93
Rate for Payer: UnitedHealthcare Community & State	$0.71
Rate for Payer: Wellpoint Medicaid Managed Care	$0.79

OMNIA VARIABLE SELF DRILL

Facility

$6,750.00

Hospital Charge Code	270693192
Hospital Revenue Code	272
Min. Negotiated Rate	$162.68
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,025.00
Rate for Payer: Oxford Commercial	$1,350.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Commercial	$1,350.00
Rate for Payer: UnitedHealthcare Community & State	$162.68
Rate for Payer: Wellpoint Medicaid Managed Care	$178.88

OMNIA VARIABLE SELF DRILL

Facility

$6,750.00

Hospital Charge Code	270693192
Hospital Revenue Code	272
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,012.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

OMNIFLOX TABS/400MG

Facility

$18.00

Hospital Charge Code	60634734
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

OMNIFLOX TABS/400MG

Facility

$18.00

Hospital Charge Code	60634734
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.40
Rate for Payer: Oxford Commercial	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$3.60
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

OMNIFLOX TABS/600MG

Facility

$21.00

Hospital Charge Code	60634735
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

OMNIFLOX TABS/600MG

Facility

$21.00

Hospital Charge Code	60634735
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

OMNIPAQIE 350 50ML VIAL

Facility

$65.65

Hospital Charge Code	601304
Hospital Revenue Code	636
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$15.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.89
Rate for Payer: Qualcare PPO/HMO/WC	$9.85

OMNIPAQIE 350 50ML VIAL

Facility

$65.65

Hospital Charge Code	601304
Hospital Revenue Code	636
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$32.83
Rate for Payer: Aetna Commercial	$24.95
Rate for Payer: Aetna Medicare Advantage	$19.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.74
Rate for Payer: Cigna Commercial	$32.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.89
Rate for Payer: Qualcare PPO/HMO/WC	$9.85
Rate for Payer: UnitedHealthcare Community & State	$1.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.74

OMNIPAQUE 180MG PER 20ML VIAL

Facility

$426.80

Hospital Charge Code	609386
Hospital Revenue Code	636
Min. Negotiated Rate	$64.02
Max. Negotiated Rate	$103.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.29
Rate for Payer: Qualcare PPO/HMO/WC	$64.02

OMNIPAQUE 180MG PER 20ML VIAL

Facility

$426.80

Hospital Charge Code	609386
Hospital Revenue Code	636
Min. Negotiated Rate	$10.29
Max. Negotiated Rate	$213.40
Rate for Payer: Aetna Commercial	$162.18
Rate for Payer: Aetna Medicare Advantage	$128.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.83
Rate for Payer: Cigna Commercial	$213.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.29
Rate for Payer: Qualcare PPO/HMO/WC	$64.02
Rate for Payer: UnitedHealthcare Community & State	$10.29
Rate for Payer: Wellpoint Medicaid Managed Care	$11.31

OMNIPAQUE 240 50ml Y250

Facility

$426.80

Hospital Charge Code	601176
Hospital Revenue Code	636
Min. Negotiated Rate	$10.29
Max. Negotiated Rate	$213.40
Rate for Payer: Aetna Commercial	$162.18
Rate for Payer: Aetna Medicare Advantage	$128.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.83
Rate for Payer: Cigna Commercial	$213.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.29
Rate for Payer: Qualcare PPO/HMO/WC	$64.02
Rate for Payer: UnitedHealthcare Community & State	$10.29
Rate for Payer: Wellpoint Medicaid Managed Care	$11.31

OMNIPAQUE 240 50ml Y250

Facility

$426.80

Hospital Charge Code	601176
Hospital Revenue Code	636
Min. Negotiated Rate	$64.02
Max. Negotiated Rate	$103.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.29
Rate for Payer: Qualcare PPO/HMO/WC	$64.02

OMNIPAQUE 240MGI/ML 10ML

Facility

$104.12

Service Code	NDC 407141210
Hospital Charge Code	606390113
Hospital Revenue Code	255
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$52.06
Rate for Payer: Aetna Commercial	$39.57
Rate for Payer: Aetna Medicare Advantage	$31.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.55
Rate for Payer: Cigna Commercial	$52.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.24
Rate for Payer: Oxford Commercial	$20.82
Rate for Payer: Qualcare PPO/HMO/WC	$15.62
Rate for Payer: UnitedHealthcare Commercial	$20.82
Rate for Payer: UnitedHealthcare Community & State	$2.51
Rate for Payer: Wellpoint Medicaid Managed Care	$2.76

OMNIPAQUE 240MGI/ML 10ML

Facility

$104.12

Service Code	NDC 407141210
Hospital Charge Code	606390113
Hospital Revenue Code	255
Min. Negotiated Rate	$15.62
Max. Negotiated Rate	$15.62
Rate for Payer: Qualcare PPO/HMO/WC	$15.62

OMNIPAQUE 240MG PER 20 ML VIAL

Facility

$426.80

Hospital Charge Code	601305
Hospital Revenue Code	636
Min. Negotiated Rate	$64.02
Max. Negotiated Rate	$103.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.29
Rate for Payer: Qualcare PPO/HMO/WC	$64.02

OMNIPAQUE 240MG PER 20 ML VIAL

Facility

$426.80

Hospital Charge Code	601305
Hospital Revenue Code	636
Min. Negotiated Rate	$10.29
Max. Negotiated Rate	$213.40
Rate for Payer: Aetna Commercial	$162.18
Rate for Payer: Aetna Medicare Advantage	$128.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.83
Rate for Payer: Cigna Commercial	$213.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.29
Rate for Payer: Qualcare PPO/HMO/WC	$64.02
Rate for Payer: UnitedHealthcare Community & State	$10.29
Rate for Payer: Wellpoint Medicaid Managed Care	$11.31

OMNIPAQUE 300 10 ML

Facility

$426.80

Hospital Charge Code	60639492
Hospital Revenue Code	636
Min. Negotiated Rate	$10.29
Max. Negotiated Rate	$213.40
Rate for Payer: Aetna Commercial	$162.18
Rate for Payer: Aetna Medicare Advantage	$128.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.83
Rate for Payer: Cigna Commercial	$213.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.29
Rate for Payer: Qualcare PPO/HMO/WC	$64.02
Rate for Payer: UnitedHealthcare Community & State	$10.29
Rate for Payer: Wellpoint Medicaid Managed Care	$11.31

OMNIPAQUE 300 10 ML

Facility

$426.80

Hospital Charge Code	60639492
Hospital Revenue Code	636
Min. Negotiated Rate	$64.02
Max. Negotiated Rate	$103.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.29
Rate for Payer: Qualcare PPO/HMO/WC	$64.02

OMNIPAQUE 320MG/ML 170ML

Facility

$3.75

Hospital Charge Code	270605515C
Hospital Revenue Code	255
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.88
Rate for Payer: Aetna Commercial	$1.43
Rate for Payer: Aetna Medicare Advantage	$1.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.96
Rate for Payer: Cigna Commercial	$1.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.12
Rate for Payer: Oxford Commercial	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.56
Rate for Payer: UnitedHealthcare Commercial	$0.75
Rate for Payer: UnitedHealthcare Community & State	$0.09
Rate for Payer: Wellpoint Medicaid Managed Care	$0.10

OMNIPAQUE 320MG/ML 170ML

Facility

$3.75

Hospital Charge Code	270605515C
Hospital Revenue Code	255
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.56
Rate for Payer: Qualcare PPO/HMO/WC	$0.56

OMNIPAQUE 350 150M FLEXPK Y495

Facility

$184.85

Hospital Charge Code	270601302
Hospital Revenue Code	250
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$92.42
Rate for Payer: Aetna Commercial	$70.24
Rate for Payer: Aetna Medicare Advantage	$55.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.14
Rate for Payer: Cigna Commercial	$92.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.45
Rate for Payer: Oxford Commercial	$36.97
Rate for Payer: Qualcare PPO/HMO/WC	$27.73
Rate for Payer: UnitedHealthcare Commercial	$36.97
Rate for Payer: UnitedHealthcare Community & State	$4.45
Rate for Payer: Wellpoint Medicaid Managed Care	$4.90

Know your out-of-pocket cost for care.

All Charges