Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OXF UNI TIB TRAY SZA RM/LL PMA

Facility

$9,900.00

Service Code	HCPCS C1776
Hospital Charge Code	270684056
Hospital Revenue Code	278
Min. Negotiated Rate	$238.59
Max. Negotiated Rate	$4,950.00
Rate for Payer: Aetna Commercial	$3,762.00
Rate for Payer: Aetna Medicare Advantage	$2,970.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,524.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,524.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,524.50
Rate for Payer: Cigna Commercial	$4,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,395.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,178.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,485.00
Rate for Payer: UnitedHealthcare Community & State	$238.59
Rate for Payer: Wellpoint Medicaid Managed Care	$262.35

OXF UNI TIB TRAY SZA RM/LL PMA

Facility

$9,900.00

Service Code	HCPCS C1776
Hospital Charge Code	270684056
Hospital Revenue Code	278
Min. Negotiated Rate	$1,485.00
Max. Negotiated Rate	$2,395.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,395.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,178.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,485.00

OXICONAZOLE 190 CREAM 30GM

Facility

$142.75

Hospital Charge Code	6017842
Hospital Revenue Code	252
Min. Negotiated Rate	$21.41
Max. Negotiated Rate	$21.41
Rate for Payer: Qualcare PPO/HMO/WC	$21.41

OXICONAZOLE 190 CREAM 30GM

Facility

$142.75

Hospital Charge Code	6017842
Hospital Revenue Code	252
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$71.38
Rate for Payer: Aetna Commercial	$54.24
Rate for Payer: Aetna Medicare Advantage	$42.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.40
Rate for Payer: Cigna Commercial	$71.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.83
Rate for Payer: Oxford Commercial	$28.55
Rate for Payer: Qualcare PPO/HMO/WC	$21.41
Rate for Payer: UnitedHealthcare Commercial	$28.55
Rate for Payer: UnitedHealthcare Community & State	$3.44
Rate for Payer: Wellpoint Medicaid Managed Care	$3.78

OXIDIZED CELLULOSE ABSORB HEMS

Facility

$341.50

Service Code	NDC 8290375846
Hospital Charge Code	60628454
Hospital Revenue Code	250
Min. Negotiated Rate	$51.23
Max. Negotiated Rate	$51.23
Rate for Payer: Qualcare PPO/HMO/WC	$51.23

OXIDIZED CELLULOSE ABSORB HEMS

Facility

$98.50

Hospital Charge Code	60628454R
Hospital Revenue Code	250
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$49.25
Rate for Payer: Aetna Commercial	$37.43
Rate for Payer: Aetna Medicare Advantage	$29.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.12
Rate for Payer: Cigna Commercial	$49.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.55
Rate for Payer: Oxford Commercial	$19.70
Rate for Payer: Qualcare PPO/HMO/WC	$14.78
Rate for Payer: UnitedHealthcare Commercial	$19.70
Rate for Payer: UnitedHealthcare Community & State	$2.37
Rate for Payer: Wellpoint Medicaid Managed Care	$2.61

OXIDIZED CELLULOSE ABSORB HEMS

Facility

$341.50

Service Code	NDC 8290375846
Hospital Charge Code	60628454
Hospital Revenue Code	250
Min. Negotiated Rate	$8.23
Max. Negotiated Rate	$170.75
Rate for Payer: Aetna Commercial	$129.77
Rate for Payer: Aetna Medicare Advantage	$102.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.08
Rate for Payer: Cigna Commercial	$170.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.45
Rate for Payer: Oxford Commercial	$68.30
Rate for Payer: Qualcare PPO/HMO/WC	$51.23
Rate for Payer: UnitedHealthcare Commercial	$68.30
Rate for Payer: UnitedHealthcare Community & State	$8.23
Rate for Payer: Wellpoint Medicaid Managed Care	$9.05

OXIDIZED CELLULOSE ABSORB HEMS

Facility

$98.50

Hospital Charge Code	60628454R
Hospital Revenue Code	250
Min. Negotiated Rate	$14.78
Max. Negotiated Rate	$14.78
Rate for Payer: Qualcare PPO/HMO/WC	$14.78

OXIDRONATE HDP KIT

Facility

$92.20

Hospital Charge Code	270658214
Hospital Revenue Code	272
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$46.10
Rate for Payer: Aetna Commercial	$35.04
Rate for Payer: Aetna Medicare Advantage	$27.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.51
Rate for Payer: Cigna Commercial	$46.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.66
Rate for Payer: Oxford Commercial	$18.44
Rate for Payer: Qualcare PPO/HMO/WC	$13.83
Rate for Payer: UnitedHealthcare Commercial	$18.44
Rate for Payer: UnitedHealthcare Community & State	$2.22
Rate for Payer: Wellpoint Medicaid Managed Care	$2.44

OXIDRONATE HDP KIT

Facility

$92.20

Hospital Charge Code	270658214
Hospital Revenue Code	272
Min. Negotiated Rate	$13.83
Max. Negotiated Rate	$13.83
Rate for Payer: Qualcare PPO/HMO/WC	$13.83

OXIMETRY*****

Facility

$83.00

Hospital Charge Code	8003493
Hospital Revenue Code	279
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$12.45
Rate for Payer: Qualcare PPO/HMO/WC	$12.45

OXIMETRY*****

Facility

$83.00

Hospital Charge Code	8003493
Hospital Revenue Code	279
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$41.50
Rate for Payer: Aetna Commercial	$31.54
Rate for Payer: Aetna Medicare Advantage	$24.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.16
Rate for Payer: Cigna Commercial	$41.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.90
Rate for Payer: Oxford Commercial	$16.60
Rate for Payer: Qualcare PPO/HMO/WC	$12.45
Rate for Payer: UnitedHealthcare Commercial	$16.60
Rate for Payer: UnitedHealthcare Community & State	$2.00
Rate for Payer: Wellpoint Medicaid Managed Care	$2.20

OXISENSOR ********

Facility

$40.00

Hospital Charge Code	1801141
Hospital Revenue Code	272
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

OXISENSOR ********

Facility

$40.00

Hospital Charge Code	1801141
Hospital Revenue Code	272
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna Commercial	$15.20
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.00
Rate for Payer: Oxford Commercial	$8.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$8.00
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

OXISENSOR ADULT DISP

Facility

$51.04

Hospital Charge Code	270649181
Hospital Revenue Code	272
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$25.52
Rate for Payer: Aetna Commercial	$19.40
Rate for Payer: Aetna Medicare Advantage	$15.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.02
Rate for Payer: Cigna Commercial	$25.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.31
Rate for Payer: Oxford Commercial	$10.21
Rate for Payer: Qualcare PPO/HMO/WC	$7.66
Rate for Payer: UnitedHealthcare Commercial	$10.21
Rate for Payer: UnitedHealthcare Community & State	$1.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1.35

OXISENSOR ADULT DISP

Facility

$51.04

Hospital Charge Code	270649181
Hospital Revenue Code	272
Min. Negotiated Rate	$7.66
Max. Negotiated Rate	$7.66
Rate for Payer: Qualcare PPO/HMO/WC	$7.66

OXISENSOR II ADULT D25

Facility

$121.05

Hospital Charge Code	270600649
Hospital Revenue Code	272
Min. Negotiated Rate	$18.16
Max. Negotiated Rate	$18.16
Rate for Payer: Qualcare PPO/HMO/WC	$18.16

OXISENSOR II ADULT D25

Facility

$121.05

Hospital Charge Code	270600649
Hospital Revenue Code	272
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$60.52
Rate for Payer: Aetna Commercial	$46.00
Rate for Payer: Aetna Medicare Advantage	$36.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.87
Rate for Payer: Cigna Commercial	$60.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.31
Rate for Payer: Oxford Commercial	$24.21
Rate for Payer: Qualcare PPO/HMO/WC	$18.16
Rate for Payer: UnitedHealthcare Commercial	$24.21
Rate for Payer: UnitedHealthcare Community & State	$2.92
Rate for Payer: Wellpoint Medicaid Managed Care	$3.21

OXISENSOR II NEONATAL/ADULT

Facility

$62.96

Hospital Charge Code	270600462
Hospital Revenue Code	270
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$31.48
Rate for Payer: Aetna Commercial	$23.92
Rate for Payer: Aetna Medicare Advantage	$18.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.05
Rate for Payer: Cigna Commercial	$31.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.89
Rate for Payer: Oxford Commercial	$12.59
Rate for Payer: Qualcare PPO/HMO/WC	$9.44
Rate for Payer: UnitedHealthcare Commercial	$12.59
Rate for Payer: UnitedHealthcare Community & State	$1.52
Rate for Payer: Wellpoint Medicaid Managed Care	$1.67

OXISENSOR II NEONATAL/ADULT

Facility

$62.96

Hospital Charge Code	270600462
Hospital Revenue Code	270
Min. Negotiated Rate	$9.44
Max. Negotiated Rate	$9.44
Rate for Payer: Qualcare PPO/HMO/WC	$9.44

OXISENSOR INFANT I20

Facility

$124.85

Hospital Charge Code	270600650
Hospital Revenue Code	272
Min. Negotiated Rate	$18.73
Max. Negotiated Rate	$18.73
Rate for Payer: Qualcare PPO/HMO/WC	$18.73

OXISENSOR INFANT I20

Facility

$124.85

Hospital Charge Code	270600650
Hospital Revenue Code	272
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$62.42
Rate for Payer: Aetna Commercial	$47.44
Rate for Payer: Aetna Medicare Advantage	$37.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.84
Rate for Payer: Cigna Commercial	$62.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.45
Rate for Payer: Oxford Commercial	$24.97
Rate for Payer: Qualcare PPO/HMO/WC	$18.73
Rate for Payer: UnitedHealthcare Commercial	$24.97
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

OXISENSOR NEONATAL

Facility

$50.61

Hospital Charge Code	270649675
Hospital Revenue Code	270
Min. Negotiated Rate	$7.59
Max. Negotiated Rate	$7.59
Rate for Payer: Qualcare PPO/HMO/WC	$7.59

OXISENSOR NEONATAL

Facility

$214.00

Hospital Charge Code	270330838
Hospital Revenue Code	272
Min. Negotiated Rate	$32.10
Max. Negotiated Rate	$32.10
Rate for Payer: Qualcare PPO/HMO/WC	$32.10

OXISENSOR NEONATAL

Facility

$214.00

Hospital Charge Code	270330838
Hospital Revenue Code	272
Min. Negotiated Rate	$5.16
Max. Negotiated Rate	$107.00
Rate for Payer: Aetna Commercial	$81.32
Rate for Payer: Aetna Medicare Advantage	$64.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.57
Rate for Payer: Cigna Commercial	$107.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.20
Rate for Payer: Oxford Commercial	$42.80
Rate for Payer: Qualcare PPO/HMO/WC	$32.10
Rate for Payer: UnitedHealthcare Commercial	$42.80
Rate for Payer: UnitedHealthcare Community & State	$5.16
Rate for Payer: Wellpoint Medicaid Managed Care	$5.67

Know your out-of-pocket cost for care.

All Charges