Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OXYCODONE TAB CR 20MG

Facility

$40.33

Service Code	NDC 59011042010
Hospital Charge Code	60628673
Hospital Revenue Code	250
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$6.05
Rate for Payer: Qualcare PPO/HMO/WC	$6.05

OXYCODONE URINE

Facility

$137.79

Service Code	HCPCS 80361
Hospital Charge Code	38478098
Hospital Revenue Code	301
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$52.36
Rate for Payer: Aetna Medicare Advantage	$41.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.14
Rate for Payer: Cigna Commercial	$68.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.34
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.67
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$22.05
Rate for Payer: Wellpoint Medicaid Managed Care	$3.65

OXYCODONE URINE

Facility

$137.79

Service Code	HCPCS 80361
Hospital Charge Code	38478098
Hospital Revenue Code	301
Min. Negotiated Rate	$20.67
Max. Negotiated Rate	$20.67
Rate for Payer: Qualcare PPO/HMO/WC	$20.67

OXYCODONE,URINE

Facility

$190.45

Service Code	HCPCS 80300
Hospital Charge Code	3009153
Hospital Revenue Code	301
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.59
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

OXYCODONE,URINE

Facility

$190.45

Service Code	HCPCS 80300
Hospital Charge Code	3009153
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

OXYCONTIN 10 MG TAB

Facility

$5.00

Hospital Charge Code	60635327
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

OXYCONTIN 10 MG TAB

Facility

$5.00

Hospital Charge Code	60635327
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

OXYCONTIN 160 MG TAB U/D

Facility

$45.00

Hospital Charge Code	60635328
Hospital Revenue Code	250
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna Commercial	$17.10
Rate for Payer: Aetna Medicare Advantage	$13.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.47
Rate for Payer: Cigna Commercial	$22.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.50
Rate for Payer: Oxford Commercial	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.75
Rate for Payer: UnitedHealthcare Commercial	$9.00
Rate for Payer: UnitedHealthcare Community & State	$1.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1.19

OXYCONTIN 160 MG TAB U/D

Facility

$45.00

Hospital Charge Code	60635328
Hospital Revenue Code	250
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$6.75
Rate for Payer: Qualcare PPO/HMO/WC	$6.75

OXYCONTIN 20 MG TAB U/D

Facility

$14.00

Hospital Charge Code	60635313
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$7.00
Rate for Payer: Aetna Commercial	$5.32
Rate for Payer: Aetna Medicare Advantage	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.57
Rate for Payer: Cigna Commercial	$7.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.20
Rate for Payer: Oxford Commercial	$2.80
Rate for Payer: Qualcare PPO/HMO/WC	$2.10
Rate for Payer: UnitedHealthcare Commercial	$2.80
Rate for Payer: UnitedHealthcare Community & State	$0.34
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

OXYCONTIN 20 MG TAB U/D

Facility

$14.00

Hospital Charge Code	60635313
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.10
Rate for Payer: Qualcare PPO/HMO/WC	$2.10

OXYCONTIN 40 MG TAB U/D

Facility

$70.89

Service Code	NDC 59011044020
Hospital Charge Code	60635312
Hospital Revenue Code	250
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$10.63
Rate for Payer: Qualcare PPO/HMO/WC	$10.63

OXYCONTIN 40 MG TAB U/D

Facility

$70.89

Service Code	NDC 59011044020
Hospital Charge Code	60635312
Hospital Revenue Code	250
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$35.45
Rate for Payer: Aetna Commercial	$26.94
Rate for Payer: Aetna Medicare Advantage	$21.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.08
Rate for Payer: Cigna Commercial	$35.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.27
Rate for Payer: Oxford Commercial	$14.18
Rate for Payer: Qualcare PPO/HMO/WC	$10.63
Rate for Payer: UnitedHealthcare Commercial	$14.18
Rate for Payer: UnitedHealthcare Community & State	$1.71
Rate for Payer: Wellpoint Medicaid Managed Care	$1.88

OXYDIZED CELLU HEM 3X3

Facility

$21.15

Hospital Charge Code	6004055
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$8.04
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.34
Rate for Payer: Oxford Commercial	$4.23
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$4.23
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

OXYDIZED CELLU HEM 3X3

Facility

$21.15

Hospital Charge Code	6004055
Hospital Revenue Code	250
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

OXYGEN 100% E TANK 2.3 CU. FT.

Facility

$135.65

Hospital Charge Code	270653642
Hospital Revenue Code	272
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$67.83
Rate for Payer: Aetna Commercial	$51.55
Rate for Payer: Aetna Medicare Advantage	$40.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.59
Rate for Payer: Cigna Commercial	$67.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.70
Rate for Payer: Oxford Commercial	$27.13
Rate for Payer: Qualcare PPO/HMO/WC	$20.35
Rate for Payer: UnitedHealthcare Commercial	$27.13
Rate for Payer: UnitedHealthcare Community & State	$3.27
Rate for Payer: Wellpoint Medicaid Managed Care	$3.59

OXYGEN 100% E TANK 2.3 CU. FT.

Facility

$135.65

Hospital Charge Code	270653642
Hospital Revenue Code	272
Min. Negotiated Rate	$20.35
Max. Negotiated Rate	$20.35
Rate for Payer: Qualcare PPO/HMO/WC	$20.35

OXYGEN SAT-EA ADD PER DAY

Facility

$105.00

Service Code	HCPCS 82810
Hospital Charge Code	7411173
Hospital Revenue Code	300
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$26.57
Rate for Payer: Aetna Medicare Advantage	$31.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.27
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: Cigna Medicare Advantage	$9.77
Rate for Payer: Clover Medicare Advantage	$9.28
Rate for Payer: EmblemHealth Commercial	$29.31
Rate for Payer: Humana Medicare Advantage	$10.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.77
Rate for Payer: Wellcare Medicare Advantage	$9.77
Rate for Payer: Wellpoint Medicaid Managed Care	$2.78

OXYGEN SAT-EA ADD PER DAY

Facility

$105.00

Service Code	HCPCS 82810
Hospital Charge Code	7411173
Hospital Revenue Code	300
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

OXYGEN SAT-INIT PER DAY

Facility

$105.00

Service Code	HCPCS 82810
Hospital Charge Code	7411171
Hospital Revenue Code	300
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$26.57
Rate for Payer: Aetna Medicare Advantage	$31.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.27
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: Cigna Medicare Advantage	$9.77
Rate for Payer: Clover Medicare Advantage	$9.28
Rate for Payer: EmblemHealth Commercial	$29.31
Rate for Payer: Humana Medicare Advantage	$10.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.77
Rate for Payer: Wellcare Medicare Advantage	$9.77
Rate for Payer: Wellpoint Medicaid Managed Care	$2.78

OXYGEN SAT-INIT PER DAY

Facility

$105.00

Service Code	HCPCS 82810
Hospital Charge Code	7411171
Hospital Revenue Code	300
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

OXYGEN STAND-BY*****

Facility

$27.00

Hospital Charge Code	9500257
Hospital Revenue Code	279
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$13.50
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	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.05
Rate for Payer: UnitedHealthcare Commercial	$5.40
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

OXYGEN STAND-BY*****

Facility

$27.00

Hospital Charge Code	9500257
Hospital Revenue Code	279
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.05

OXYGEN SUPPLY

Facility

$450.00

Hospital Charge Code	270339090
Hospital Revenue Code	272
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.00
Rate for Payer: Oxford Commercial	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Commercial	$90.00
Rate for Payer: UnitedHealthcare Community & State	$10.85
Rate for Payer: Wellpoint Medicaid Managed Care	$11.93

OXYGEN SUPPLY

Facility

$450.00

Hospital Charge Code	270339090
Hospital Revenue Code	272
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

Know your out-of-pocket cost for care.

All Charges