Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OXAPROZIN 600 MG TAB

Facility

$15.05

Hospital Charge Code	60628671
Hospital Revenue Code	250
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$2.26
Rate for Payer: Qualcare PPO/HMO/WC	$2.26

OXAZEPAM

Facility

$127.15

Service Code	HCPCS 80346
Hospital Charge Code	39900445
Hospital Revenue Code	301
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$48.32
Rate for Payer: Aetna Medicare Advantage	$38.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.42
Rate for Payer: Cigna Commercial	$63.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.15
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.07
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.96
Rate for Payer: Wellpoint Medicaid Managed Care	$3.37

OXAZEPAM

Facility

$127.15

Service Code	HCPCS 80346
Hospital Charge Code	39900445
Hospital Revenue Code	301
Min. Negotiated Rate	$19.07
Max. Negotiated Rate	$19.07
Rate for Payer: Qualcare PPO/HMO/WC	$19.07

OXAZEPAM 10MG CAPSULE

Facility

$7.25

Hospital Charge Code	60629039
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.62
Rate for Payer: Aetna Commercial	$2.75
Rate for Payer: Aetna Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.85
Rate for Payer: Cigna Commercial	$3.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.17
Rate for Payer: Oxford Commercial	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$1.45
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

OXAZEPAM 10MG CAPSULE

Facility

$7.25

Hospital Charge Code	60629039
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

OXCARBAZEPINE 150 MG TAB

Facility

$9.65

Service Code	NDC 51991029201
Hospital Charge Code	60629111
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.90
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$1.93
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

OXCARBAZEPINE 150 MG TAB

Facility

$9.65

Service Code	NDC 51991029201
Hospital Charge Code	60629111
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

OXCARBAZEPINE 300 MG TAB

Facility

$17.62

Service Code	NDC 51991029301
Hospital Charge Code	60628978
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$8.81
Rate for Payer: Aetna Commercial	$6.70
Rate for Payer: Aetna Medicare Advantage	$5.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.49
Rate for Payer: Cigna Commercial	$8.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.29
Rate for Payer: Oxford Commercial	$3.52
Rate for Payer: Qualcare PPO/HMO/WC	$2.64
Rate for Payer: UnitedHealthcare Commercial	$3.52
Rate for Payer: UnitedHealthcare Community & State	$0.42
Rate for Payer: Wellpoint Medicaid Managed Care	$0.47

OXCARBAZEPINE 300 MG TAB

Facility

$17.62

Service Code	NDC 51991029301
Hospital Charge Code	60628978
Hospital Revenue Code	250
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$2.64
Rate for Payer: Qualcare PPO/HMO/WC	$2.64

OXCARBAZEPINE, DRUG QUANTITATI

Facility

$127.84

Service Code	HCPCS 83789
Hospital Charge Code	38472340
Hospital Revenue Code	301
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$65.58
Rate for Payer: Aetna Medicare Advantage	$78.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.03
Rate for Payer: Cigna Commercial	$63.92
Rate for Payer: Cigna Medicare Advantage	$24.11
Rate for Payer: Clover Medicare Advantage	$22.90
Rate for Payer: EmblemHealth Commercial	$72.33
Rate for Payer: Humana Medicare Advantage	$24.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.35
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.18
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.11
Rate for Payer: Wellcare Medicare Advantage	$24.11
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

OXCARBAZEPINE, DRUG QUANTITATI

Facility

$127.84

Service Code	HCPCS 83789
Hospital Charge Code	38472340
Hospital Revenue Code	301
Min. Negotiated Rate	$19.18
Max. Negotiated Rate	$19.18
Rate for Payer: Qualcare PPO/HMO/WC	$19.18

OXCARBAZEPINE METABOLITE SERUM

Facility

$667.59

Service Code	HCPCS 80183
Hospital Charge Code	3036033
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

OXCARBAZEPINE METABOLITE SERUM

Facility

$667.59

Service Code	HCPCS 80183
Hospital Charge Code	3036033
Hospital Revenue Code	301
Min. Negotiated Rate	$10.60
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$36.04
Rate for Payer: Aetna Medicare Advantage	$42.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.83
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$13.25
Rate for Payer: Clover Medicare Advantage	$12.59
Rate for Payer: EmblemHealth Commercial	$39.75
Rate for Payer: Humana Medicare Advantage	$13.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.25
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	$10.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.25
Rate for Payer: Wellcare Medicare Advantage	$13.25
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

OXCARBAZEPINE-TRILEPTAL SERUM

Facility

$181.65

Service Code	HCPCS 82542
Hospital Charge Code	3035046
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

OXCARBAZEPINE-TRILEPTAL SERUM

Facility

$181.65

Service Code	HCPCS 82542
Hospital Charge Code	3035046
Hospital Revenue Code	301
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$65.52
Rate for Payer: Aetna Medicare Advantage	$78.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.96
Rate for Payer: Cigna Commercial	$90.83
Rate for Payer: Cigna Medicare Advantage	$24.09
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Medicare Advantage	$24.09
Rate for Payer: Wellpoint Medicaid Managed Care	$4.81

OXCARBEZEPINE 300 MG/5ML SUSPN

Facility

$36.58

Service Code	NDC 65162064978
Hospital Charge Code	606351007
Hospital Revenue Code	250
Min. Negotiated Rate	$5.49
Max. Negotiated Rate	$5.49
Rate for Payer: Qualcare PPO/HMO/WC	$5.49

OXCARBEZEPINE 300 MG/5ML SUSPN

Facility

$36.58

Service Code	NDC 65162064978
Hospital Charge Code	606351007
Hospital Revenue Code	250
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$18.29
Rate for Payer: Aetna Commercial	$13.90
Rate for Payer: Aetna Medicare Advantage	$10.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.33
Rate for Payer: Cigna Commercial	$18.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.97
Rate for Payer: Oxford Commercial	$7.32
Rate for Payer: Qualcare PPO/HMO/WC	$5.49
Rate for Payer: UnitedHealthcare Commercial	$7.32
Rate for Payer: UnitedHealthcare Community & State	$0.88
Rate for Payer: Wellpoint Medicaid Managed Care	$0.97

OXEPA

Facility

$54.00

Hospital Charge Code	60635267
Hospital Revenue Code	250
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Qualcare PPO/HMO/WC	$8.10

OXEPA

Facility

$54.00

Hospital Charge Code	60635267
Hospital Revenue Code	250
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna Commercial	$20.52
Rate for Payer: Aetna Medicare Advantage	$16.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.77
Rate for Payer: Cigna Commercial	$27.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.20
Rate for Payer: Oxford Commercial	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$8.10
Rate for Payer: UnitedHealthcare Commercial	$10.80
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.43

OXF ANAT BRG LT MD SIZE 4 PMA

Facility

$7,200.00

Service Code	HCPCS C1776
Hospital Charge Code	270665189
Hospital Revenue Code	278
Min. Negotiated Rate	$173.52
Max. Negotiated Rate	$3,600.00
Rate for Payer: Aetna Commercial	$2,736.00
Rate for Payer: Aetna Medicare Advantage	$2,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,836.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,836.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,836.00
Rate for Payer: Cigna Commercial	$3,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,584.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,080.00
Rate for Payer: UnitedHealthcare Community & State	$173.52
Rate for Payer: Wellpoint Medicaid Managed Care	$190.80

OXF ANAT BRG LT MD SIZE 4 PMA

Facility

$7,200.00

Service Code	HCPCS C1776
Hospital Charge Code	270665189
Hospital Revenue Code	278
Min. Negotiated Rate	$1,080.00
Max. Negotiated Rate	$1,742.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,584.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,080.00

OXF SAWBLADE STRYKER CMNTD 3PK

Facility

$2,625.00

Hospital Charge Code	270684057
Hospital Revenue Code	272
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$393.75
Rate for Payer: Qualcare PPO/HMO/WC	$393.75

OXF SAWBLADE STRYKER CMNTD 3PK

Facility

$2,625.00

Hospital Charge Code	270684057
Hospital Revenue Code	272
Min. Negotiated Rate	$63.26
Max. Negotiated Rate	$1,312.50
Rate for Payer: Aetna Commercial	$997.50
Rate for Payer: Aetna Medicare Advantage	$787.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.38
Rate for Payer: Cigna Commercial	$1,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.50
Rate for Payer: Oxford Commercial	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$393.75
Rate for Payer: UnitedHealthcare Commercial	$525.00
Rate for Payer: UnitedHealthcare Community & State	$63.26
Rate for Payer: Wellpoint Medicaid Managed Care	$69.56

OXF TWIN PEG CMNTD FEM MD PMA

Facility

$14,100.00

Service Code	HCPCS C1776
Hospital Charge Code	270665188
Hospital Revenue Code	278
Min. Negotiated Rate	$339.81
Max. Negotiated Rate	$7,050.00
Rate for Payer: Aetna Commercial	$5,358.00
Rate for Payer: Aetna Medicare Advantage	$4,230.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,595.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,595.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,820.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,595.50
Rate for Payer: Cigna Commercial	$7,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,412.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,102.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,115.00
Rate for Payer: UnitedHealthcare Community & State	$339.81
Rate for Payer: Wellpoint Medicaid Managed Care	$373.65

OXF TWIN PEG CMNTD FEM MD PMA

Facility

$14,100.00

Service Code	HCPCS C1776
Hospital Charge Code	270665188
Hospital Revenue Code	278
Min. Negotiated Rate	$2,115.00
Max. Negotiated Rate	$3,412.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,820.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,412.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,102.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,115.00

Know your out-of-pocket cost for care.

All Charges