Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OSCAL W/ VIT D/250MG/TAB

Facility

$1.00

Hospital Charge Code	60634304
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: Oxford Commercial	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.20
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

OSCILLATING SAW ATTACHMENT

Facility

$9,924.00

Hospital Charge Code	270674162
Hospital Revenue Code	272
Min. Negotiated Rate	$1,488.60
Max. Negotiated Rate	$1,488.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,488.60

OSCILLATING SAW ATTACHMENT

Facility

$9,924.00

Hospital Charge Code	270674162
Hospital Revenue Code	272
Min. Negotiated Rate	$239.17
Max. Negotiated Rate	$4,962.00
Rate for Payer: Aetna Commercial	$3,771.12
Rate for Payer: Aetna Medicare Advantage	$2,977.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,530.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,530.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,530.62
Rate for Payer: Cigna Commercial	$4,962.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,977.20
Rate for Payer: Oxford Commercial	$1,984.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,488.60
Rate for Payer: UnitedHealthcare Commercial	$1,984.80
Rate for Payer: UnitedHealthcare Community & State	$239.17
Rate for Payer: Wellpoint Medicaid Managed Care	$262.99

OSELTAMAVIR COMPOUNDED 15MG/ML

Facility

$19.36

Service Code	NDC 93818064
Hospital Charge Code	606390534
Hospital Revenue Code	250
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$2.90

OSELTAMAVIR COMPOUNDED 15MG/ML

Facility

$19.36

Service Code	NDC 93818064
Hospital Charge Code	606390534
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$9.68
Rate for Payer: Aetna Commercial	$7.36
Rate for Payer: Aetna Medicare Advantage	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.94
Rate for Payer: Cigna Commercial	$9.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.81
Rate for Payer: Oxford Commercial	$3.87
Rate for Payer: Qualcare PPO/HMO/WC	$2.90
Rate for Payer: UnitedHealthcare Commercial	$3.87
Rate for Payer: UnitedHealthcare Community & State	$0.47
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

OSELTAMIVIR 45MG CAP

Facility

$4.81

Hospital Charge Code	606390582
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$0.72
Rate for Payer: Qualcare PPO/HMO/WC	$0.72

OSELTAMIVIR 45MG CAP

Facility

$4.81

Hospital Charge Code	606390582
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.40
Rate for Payer: Aetna Commercial	$1.83
Rate for Payer: Aetna Medicare Advantage	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.23
Rate for Payer: Cigna Commercial	$2.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.44
Rate for Payer: Oxford Commercial	$0.96
Rate for Payer: Qualcare PPO/HMO/WC	$0.72
Rate for Payer: UnitedHealthcare Commercial	$0.96
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

OSELTAMIVIR 45MG CAP

Facility

$95.01

Service Code	NDC 31722063131
Hospital Charge Code	606390603
Hospital Revenue Code	250
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$47.51
Rate for Payer: Aetna Commercial	$36.10
Rate for Payer: Aetna Medicare Advantage	$28.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.23
Rate for Payer: Cigna Commercial	$47.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.50
Rate for Payer: Oxford Commercial	$19.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.25
Rate for Payer: UnitedHealthcare Commercial	$19.00
Rate for Payer: UnitedHealthcare Community & State	$2.29
Rate for Payer: Wellpoint Medicaid Managed Care	$2.52

OSELTAMIVIR 45MG CAP

Facility

$95.01

Service Code	NDC 31722063131
Hospital Charge Code	606390603
Hospital Revenue Code	250
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

OSELTAMIVIR 75 MG CAP

Facility

$96.95

Service Code	NDC 4080085
Hospital Charge Code	60629906
Hospital Revenue Code	250
Min. Negotiated Rate	$14.54
Max. Negotiated Rate	$14.54
Rate for Payer: Qualcare PPO/HMO/WC	$14.54

OSELTAMIVIR 75 MG CAP

Facility

$96.95

Service Code	NDC 4080085
Hospital Charge Code	60629906
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$48.48
Rate for Payer: Aetna Commercial	$36.84
Rate for Payer: Aetna Medicare Advantage	$29.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.72
Rate for Payer: Cigna Commercial	$48.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.09
Rate for Payer: Oxford Commercial	$19.39
Rate for Payer: Qualcare PPO/HMO/WC	$14.54
Rate for Payer: UnitedHealthcare Commercial	$19.39
Rate for Payer: UnitedHealthcare Community & State	$2.34
Rate for Payer: Wellpoint Medicaid Managed Care	$2.57

OSELTAMIVIR PHOSPHATE CAP 30MG

Facility

$95.01

Service Code	NDC 47781046813
Hospital Charge Code	606390168
Hospital Revenue Code	250
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$47.51
Rate for Payer: Aetna Commercial	$36.10
Rate for Payer: Aetna Medicare Advantage	$28.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.23
Rate for Payer: Cigna Commercial	$47.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.50
Rate for Payer: Oxford Commercial	$19.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.25
Rate for Payer: UnitedHealthcare Commercial	$19.00
Rate for Payer: UnitedHealthcare Community & State	$2.29
Rate for Payer: Wellpoint Medicaid Managed Care	$2.52

OSELTAMIVIR PHOSPHATE CAP 30MG

Facility

$95.01

Service Code	NDC 47781046813
Hospital Charge Code	606390168
Hospital Revenue Code	250
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

OSMITROL 5% 1000 **********

Facility

$60.00

Hospital Charge Code	7000284
Hospital Revenue Code	258
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Commercial	$22.80
Rate for Payer: Aetna Medicare Advantage	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.30
Rate for Payer: Cigna Commercial	$30.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.00
Rate for Payer: Oxford Commercial	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
Rate for Payer: UnitedHealthcare Commercial	$12.00
Rate for Payer: UnitedHealthcare Community & State	$1.45
Rate for Payer: Wellpoint Medicaid Managed Care	$1.59

OSMITROL 5% 1000 **********

Facility

$60.00

Hospital Charge Code	7000284
Hospital Revenue Code	258
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

OSMOGLYN 50%/220ML

Facility

$107.00

Hospital Charge Code	60633595
Hospital Revenue Code	250
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$53.50
Rate for Payer: Aetna Commercial	$40.66
Rate for Payer: Aetna Medicare Advantage	$32.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.29
Rate for Payer: Cigna Commercial	$53.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.10
Rate for Payer: Oxford Commercial	$21.40
Rate for Payer: Qualcare PPO/HMO/WC	$16.05
Rate for Payer: UnitedHealthcare Commercial	$21.40
Rate for Payer: UnitedHealthcare Community & State	$2.58
Rate for Payer: Wellpoint Medicaid Managed Care	$2.84

OSMOGLYN 50%/220ML

Facility

$107.00

Hospital Charge Code	60633595
Hospital Revenue Code	250
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$16.05
Rate for Payer: Qualcare PPO/HMO/WC	$16.05

OSMOLAITY***

Facility

$27.00

Hospital Charge Code	3012002
Hospital Revenue Code	309
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.05

OSMOLAITY***

Facility

$27.00

Hospital Charge Code	3012002
Hospital Revenue Code	309
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$10.26
Rate for Payer: Aetna Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.88
Rate for Payer: Cigna Commercial	$13.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

***OSMOLALITY FLUID***

Facility

$85.00

Service Code	HCPCS 84999
Hospital Charge Code	3009884
Hospital Revenue Code	301
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$12.75
Rate for Payer: Qualcare PPO/HMO/WC	$12.75

***OSMOLALITY FLUID***

Facility

$85.00

Service Code	HCPCS 84999
Hospital Charge Code	3009884
Hospital Revenue Code	301
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.30
Rate for Payer: Aetna Medicare Advantage	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.68
Rate for Payer: Cigna Commercial	$42.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.05
Rate for Payer: Wellpoint Medicaid Managed Care	$2.25

OSMOLALITY FLUID

Facility

$246.45

Service Code	HCPCS 84999
Hospital Charge Code	3009885
Hospital Revenue Code	301
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$93.65
Rate for Payer: Aetna Medicare Advantage	$73.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.84
Rate for Payer: Cigna Commercial	$123.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.94
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.97
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.94
Rate for Payer: Wellpoint Medicaid Managed Care	$6.53

OSMOLALITY FLUID

Facility

$246.45

Service Code	HCPCS 84999
Hospital Charge Code	3009885
Hospital Revenue Code	301
Min. Negotiated Rate	$36.97
Max. Negotiated Rate	$36.97
Rate for Payer: Qualcare PPO/HMO/WC	$36.97

OSMOLALITY, SERUM

Facility

$667.59

Service Code	HCPCS 83930
Hospital Charge Code	3002003
Hospital Revenue Code	301
Min. Negotiated Rate	$5.29
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$17.98
Rate for Payer: Aetna Medicare Advantage	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.86
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$6.61
Rate for Payer: Clover Medicare Advantage	$6.28
Rate for Payer: EmblemHealth Commercial	$19.83
Rate for Payer: Humana Medicare Advantage	$6.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.61
Rate for Payer: Wellcare Medicare Advantage	$6.61
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

OSMOLALITY, SERUM

Facility

$667.59

Service Code	HCPCS 83930
Hospital Charge Code	3002003
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

Know your out-of-pocket cost for care.

All Charges