Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OXYGEN U.S.P.

Facility

$3,429.11

Hospital Charge Code	270616668
Hospital Revenue Code	270
Min. Negotiated Rate	$82.64
Max. Negotiated Rate	$1,714.56
Rate for Payer: Aetna Commercial	$1,303.06
Rate for Payer: Aetna Medicare Advantage	$1,028.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$874.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$874.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$874.42
Rate for Payer: Cigna Commercial	$1,714.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.73
Rate for Payer: Oxford Commercial	$685.82
Rate for Payer: Qualcare PPO/HMO/WC	$514.37
Rate for Payer: UnitedHealthcare Commercial	$685.82
Rate for Payer: UnitedHealthcare Community & State	$82.64
Rate for Payer: Wellpoint Medicaid Managed Care	$90.87

OXYGEN U.S.P.

Facility

$3,429.11

Hospital Charge Code	270616668
Hospital Revenue Code	270
Min. Negotiated Rate	$514.37
Max. Negotiated Rate	$514.37
Rate for Payer: Qualcare PPO/HMO/WC	$514.37

OXYHOOD DISP INFANT

Facility

$52.00

Hospital Charge Code	1801109
Hospital Revenue Code	272
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$26.00
Rate for Payer: Aetna Commercial	$19.76
Rate for Payer: Aetna Medicare Advantage	$15.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.26
Rate for Payer: Cigna Commercial	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.60
Rate for Payer: Oxford Commercial	$10.40
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Commercial	$10.40
Rate for Payer: UnitedHealthcare Community & State	$1.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1.38

OXYHOOD DISP INFANT

Facility

$52.00

Hospital Charge Code	1801109
Hospital Revenue Code	272
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

OXYHOOD LARGE DISP

Facility

$682.45

Hospital Charge Code	270614394
Hospital Revenue Code	272
Min. Negotiated Rate	$16.45
Max. Negotiated Rate	$341.23
Rate for Payer: Aetna Commercial	$259.33
Rate for Payer: Aetna Medicare Advantage	$204.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$174.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$174.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$174.02
Rate for Payer: Cigna Commercial	$341.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.74
Rate for Payer: Oxford Commercial	$136.49
Rate for Payer: Qualcare PPO/HMO/WC	$102.37
Rate for Payer: UnitedHealthcare Commercial	$136.49
Rate for Payer: UnitedHealthcare Community & State	$16.45
Rate for Payer: Wellpoint Medicaid Managed Care	$18.08

OXYHOOD LARGE DISP

Facility

$682.45

Hospital Charge Code	270614394
Hospital Revenue Code	272
Min. Negotiated Rate	$102.37
Max. Negotiated Rate	$102.37
Rate for Payer: Qualcare PPO/HMO/WC	$102.37

OXYIR 5 MG

Facility

$3.00

Hospital Charge Code	60635323
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

OXYIR 5 MG

Facility

$3.00

Hospital Charge Code	60635323
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

OXYMETAZOLINE NASAL

Facility

$9.00

Hospital Charge Code	6013098
Hospital Revenue Code	251
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

OXYMETAZOLINE NASAL

Facility

$9.00

Hospital Charge Code	6013098
Hospital Revenue Code	251
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

OXYMETAZOLINE NSL SPR 0.05%

Facility

$26.73

Service Code	NDC 45802041059
Hospital Charge Code	60628076
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$13.37
Rate for Payer: Aetna Commercial	$10.16
Rate for Payer: Aetna Medicare Advantage	$8.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.82
Rate for Payer: Cigna Commercial	$13.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.02
Rate for Payer: Oxford Commercial	$5.35
Rate for Payer: Qualcare PPO/HMO/WC	$4.01
Rate for Payer: UnitedHealthcare Commercial	$5.35
Rate for Payer: UnitedHealthcare Community & State	$0.64
Rate for Payer: Wellpoint Medicaid Managed Care	$0.71

OXYMETAZOLINE NSL SPR 0.05%

Facility

$26.73

Service Code	NDC 45802041059
Hospital Charge Code	60628076
Hospital Revenue Code	250
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$4.01
Rate for Payer: Qualcare PPO/HMO/WC	$4.01

OXYTOCIN 10 UNITS/ML INJ

Facility

$7.24

Service Code	HCPCS J2590
Hospital Charge Code	60628284
Hospital Revenue Code	636
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.75
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

OXYTOCIN 10 UNITS/ML INJ

Facility

$7.24

Service Code	HCPCS J2590
Hospital Charge Code	60628284
Hospital Revenue Code	636
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	$1.75
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

OXYTOCIN 30 U 0.9 SOD CHL NS

Facility

$72.29

Service Code	HCPCS J2590
Hospital Charge Code	606350996
Hospital Revenue Code	636
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$36.15
Rate for Payer: Aetna Commercial	$27.47
Rate for Payer: Aetna Medicare Advantage	$21.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.43
Rate for Payer: Cigna Commercial	$36.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.49
Rate for Payer: Qualcare PPO/HMO/WC	$10.84
Rate for Payer: UnitedHealthcare Community & State	$1.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1.92

OXYTOCIN 30 U 0.9 SOD CHL NS

Facility

$72.29

Service Code	HCPCS J2590
Hospital Charge Code	606350996
Hospital Revenue Code	636
Min. Negotiated Rate	$10.84
Max. Negotiated Rate	$17.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.49
Rate for Payer: Qualcare PPO/HMO/WC	$10.84

OXYTOCIN 30U IN 500ML OF LR

Facility

$115.51

Service Code	HCPCS J2590
Hospital Charge Code	606361022
Hospital Revenue Code	636
Min. Negotiated Rate	$17.33
Max. Negotiated Rate	$27.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.95
Rate for Payer: Qualcare PPO/HMO/WC	$17.33

OXYTOCIN 30U IN 500ML OF LR

Facility

$115.51

Service Code	HCPCS J2590
Hospital Charge Code	606361022
Hospital Revenue Code	636
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$57.76
Rate for Payer: Aetna Commercial	$43.89
Rate for Payer: Aetna Medicare Advantage	$34.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.46
Rate for Payer: Cigna Commercial	$57.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.95
Rate for Payer: Qualcare PPO/HMO/WC	$17.33
Rate for Payer: UnitedHealthcare Community & State	$2.78
Rate for Payer: Wellpoint Medicaid Managed Care	$3.06

OXYTOCIN 30UNIT .9% 500ML

Facility

$31.20

Hospital Charge Code	60635760
Hospital Revenue Code	636
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$15.60
Rate for Payer: Aetna Commercial	$11.86
Rate for Payer: Aetna Medicare Advantage	$9.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.96
Rate for Payer: Cigna Commercial	$15.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.55
Rate for Payer: Qualcare PPO/HMO/WC	$4.68
Rate for Payer: UnitedHealthcare Community & State	$0.75
Rate for Payer: Wellpoint Medicaid Managed Care	$0.83

OXYTOCIN 30UNIT .9% 500ML

Facility

$31.20

Hospital Charge Code	60635760
Hospital Revenue Code	636
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$7.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.55
Rate for Payer: Qualcare PPO/HMO/WC	$4.68

OXYTOCIN 30UNITS.9% 500ML

Facility

$31.20

Hospital Charge Code	60635769
Hospital Revenue Code	636
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$7.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.55
Rate for Payer: Qualcare PPO/HMO/WC	$4.68

OXYTOCIN 30UNITS.9% 500ML

Facility

$31.20

Hospital Charge Code	60635769
Hospital Revenue Code	636
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$15.60
Rate for Payer: Aetna Commercial	$11.86
Rate for Payer: Aetna Medicare Advantage	$9.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.96
Rate for Payer: Cigna Commercial	$15.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.55
Rate for Payer: Qualcare PPO/HMO/WC	$4.68
Rate for Payer: UnitedHealthcare Community & State	$0.75
Rate for Payer: Wellpoint Medicaid Managed Care	$0.83

OXYTOCIN CHALLENGE TEST

Facility

$669.00

Service Code	HCPCS 59020
Hospital Charge Code	83653010
Hospital Revenue Code	720
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$4,601.00
Rate for Payer: Aetna Commercial	$653.29
Rate for Payer: Aetna Medicare Advantage	$778.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$866.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$866.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$240.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$76.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$866.98
Rate for Payer: Cigna Commercial	$481.45
Rate for Payer: Cigna Medicare Advantage	$240.18
Rate for Payer: Clover Medicare Advantage	$228.17
Rate for Payer: EmblemHealth Commercial	$720.54
Rate for Payer: Humana Medicare Advantage	$247.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$240.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.70
Rate for Payer: Oxford Commercial	$2,624.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.35
Rate for Payer: UnitedHealthcare Commercial	$4,601.00
Rate for Payer: UnitedHealthcare Community & State	$16.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$240.18
Rate for Payer: Wellcare Medicare Advantage	$240.18
Rate for Payer: Wellpoint Medicaid Managed Care	$17.73

OXYTOCIN CHALLENGE TEST

Facility

$669.00

Service Code	HCPCS 59020
Hospital Charge Code	83653010
Hospital Revenue Code	720
Min. Negotiated Rate	$100.35
Max. Negotiated Rate	$100.35
Rate for Payer: Qualcare PPO/HMO/WC	$100.35

OYSTER IGE

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	401186003I
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges