Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SABER-C PLATE 14X17X6MM

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705814
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

SABER-C PLATE 14X17X7MM 6DEG

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705812
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

SABER-C PLATE 14X17X7MM 6DEG

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705812
Hospital Revenue Code	278
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

SABER-C SPIKE

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705811
Hospital Revenue Code	278
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

SABER-C SPIKE

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705811
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

SABLE SPACER 12X30, 7-14MM 15D

Facility

$29,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270704736
Hospital Revenue Code	278
Min. Negotiated Rate	$704.92
Max. Negotiated Rate	$14,625.00
Rate for Payer: Aetna Commercial	$11,115.00
Rate for Payer: Aetna Medicare Advantage	$8,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,458.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,458.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,458.75
Rate for Payer: Cigna Commercial	$14,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,078.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,435.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,387.50
Rate for Payer: UnitedHealthcare Community & State	$704.92
Rate for Payer: Wellpoint Medicaid Managed Care	$775.12

SABLE SPACER 12X30, 7-14MM 15D

Facility

$29,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270704736
Hospital Revenue Code	278
Min. Negotiated Rate	$4,387.50
Max. Negotiated Rate	$7,078.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,078.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,435.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,387.50

SACCHAROMYCES CEREVISIAE

Facility

$84.25

Service Code	HCPCS 86671
Hospital Charge Code	39900236
Hospital Revenue Code	302
Min. Negotiated Rate	$12.64
Max. Negotiated Rate	$12.64
Rate for Payer: Qualcare PPO/HMO/WC	$12.64

SACCHAROMYCES CEREVISIAE

Facility

$84.25

Service Code	HCPCS 86671
Hospital Charge Code	39900236
Hospital Revenue Code	302
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$33.32
Rate for Payer: Aetna Medicare Advantage	$39.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.22
Rate for Payer: Cigna Commercial	$42.12
Rate for Payer: Cigna Medicare Advantage	$12.25
Rate for Payer: Clover Medicare Advantage	$11.64
Rate for Payer: EmblemHealth Commercial	$36.75
Rate for Payer: Humana Medicare Advantage	$12.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.27
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.64
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.25
Rate for Payer: Wellcare Medicare Advantage	$12.25
Rate for Payer: Wellpoint Medicaid Managed Care	$2.23

SACCOMANNO CELL TRANS SYS

Facility

$20.00

Hospital Charge Code	270657259
Hospital Revenue Code	272
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00

SACCOMANNO CELL TRANS SYS

Facility

$20.00

Hospital Charge Code	270657259
Hospital Revenue Code	272
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$10.00
Rate for Payer: Aetna Commercial	$7.60
Rate for Payer: Aetna Medicare Advantage	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.10
Rate for Payer: Cigna Commercial	$10.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.00
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00
Rate for Payer: UnitedHealthcare Commercial	$4.00
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

SA COVER PLATE, LARGE

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270705952
Hospital Revenue Code	278
Min. Negotiated Rate	$59.65
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Commercial	$940.50
Rate for Payer: Aetna Medicare Advantage	$742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.12
Rate for Payer: Cigna Commercial	$1,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$371.25
Rate for Payer: UnitedHealthcare Community & State	$59.65
Rate for Payer: Wellpoint Medicaid Managed Care	$65.59

SA COVER PLATE, LARGE

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270705952
Hospital Revenue Code	278
Min. Negotiated Rate	$371.25
Max. Negotiated Rate	$598.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$371.25

SACRUM AND COCCYX

Facility

$5,100.00

Service Code	HCPCS 72220
Hospital Charge Code	94061101
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

SACRUM AND COCCYX

Facility

$5,100.00

Service Code	HCPCS 72220
Hospital Charge Code	94061101
Hospital Revenue Code	320
Min. Negotiated Rate	$31.94
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$373.21
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$72.37
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$247.19
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

SACUBITRAL/VALSARTAN 97/103 MG

Facility

$46.03

Service Code	NDC 78069635
Hospital Charge Code	606390144
Hospital Revenue Code	250
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$6.90
Rate for Payer: Qualcare PPO/HMO/WC	$6.90

SACUBITRAL/VALSARTAN 97/103 MG

Facility

$46.03

Service Code	NDC 78069635
Hospital Charge Code	606390144
Hospital Revenue Code	250
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$23.02
Rate for Payer: Aetna Commercial	$17.49
Rate for Payer: Aetna Medicare Advantage	$13.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.74
Rate for Payer: Cigna Commercial	$23.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.81
Rate for Payer: Oxford Commercial	$9.21
Rate for Payer: Qualcare PPO/HMO/WC	$6.90
Rate for Payer: UnitedHealthcare Commercial	$9.21
Rate for Payer: UnitedHealthcare Community & State	$1.11
Rate for Payer: Wellpoint Medicaid Managed Care	$1.22

SACUBITRIL/VALSARTAN 24-26mg

Facility

$108.41

Service Code	NDC 78065920
Hospital Charge Code	606390104
Hospital Revenue Code	250
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$54.20
Rate for Payer: Aetna Commercial	$41.20
Rate for Payer: Aetna Medicare Advantage	$32.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.64
Rate for Payer: Cigna Commercial	$54.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.52
Rate for Payer: Oxford Commercial	$21.68
Rate for Payer: Qualcare PPO/HMO/WC	$16.26
Rate for Payer: UnitedHealthcare Commercial	$21.68
Rate for Payer: UnitedHealthcare Community & State	$2.61
Rate for Payer: Wellpoint Medicaid Managed Care	$2.87

SACUBITRIL/VALSARTAN 24-26mg

Facility

$108.41

Service Code	NDC 78065920
Hospital Charge Code	606390104
Hospital Revenue Code	250
Min. Negotiated Rate	$16.26
Max. Negotiated Rate	$16.26
Rate for Payer: Qualcare PPO/HMO/WC	$16.26

SACUBITRIL/VALSARTAN 49-51mg

Facility

$108.41

Service Code	NDC 78077720
Hospital Charge Code	606390105
Hospital Revenue Code	250
Min. Negotiated Rate	$16.26
Max. Negotiated Rate	$16.26
Rate for Payer: Qualcare PPO/HMO/WC	$16.26

SACUBITRIL/VALSARTAN 49-51mg

Facility

$108.41

Service Code	NDC 78077720
Hospital Charge Code	606390105
Hospital Revenue Code	250
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$54.20
Rate for Payer: Aetna Commercial	$41.20
Rate for Payer: Aetna Medicare Advantage	$32.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.64
Rate for Payer: Cigna Commercial	$54.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.52
Rate for Payer: Oxford Commercial	$21.68
Rate for Payer: Qualcare PPO/HMO/WC	$16.26
Rate for Payer: UnitedHealthcare Commercial	$21.68
Rate for Payer: UnitedHealthcare Community & State	$2.61
Rate for Payer: Wellpoint Medicaid Managed Care	$2.87

SAFEGUARD 24CM

Facility

$29.50

Hospital Charge Code	2709006961
Hospital Revenue Code	272
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$4.42
Rate for Payer: Qualcare PPO/HMO/WC	$4.42

SAFEGUARD 24CM

Facility

$295.00

Hospital Charge Code	270657684
Hospital Revenue Code	270
Min. Negotiated Rate	$44.25
Max. Negotiated Rate	$44.25
Rate for Payer: Qualcare PPO/HMO/WC	$44.25

SAFEGUARD 24CM

Facility

$29.50

Hospital Charge Code	2709006961
Hospital Revenue Code	272
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$14.75
Rate for Payer: Aetna Commercial	$11.21
Rate for Payer: Aetna Medicare Advantage	$8.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.52
Rate for Payer: Cigna Commercial	$14.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.85
Rate for Payer: Oxford Commercial	$5.90
Rate for Payer: Qualcare PPO/HMO/WC	$4.42
Rate for Payer: UnitedHealthcare Commercial	$5.90
Rate for Payer: UnitedHealthcare Community & State	$0.71
Rate for Payer: Wellpoint Medicaid Managed Care	$0.78

SAFEGUARD 24CM

Facility

$295.00

Hospital Charge Code	270657684
Hospital Revenue Code	270
Min. Negotiated Rate	$7.11
Max. Negotiated Rate	$147.50
Rate for Payer: Aetna Commercial	$112.10
Rate for Payer: Aetna Medicare Advantage	$88.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.22
Rate for Payer: Cigna Commercial	$147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.50
Rate for Payer: Oxford Commercial	$59.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.25
Rate for Payer: UnitedHealthcare Commercial	$59.00
Rate for Payer: UnitedHealthcare Community & State	$7.11
Rate for Payer: Wellpoint Medicaid Managed Care	$7.82

Know your out-of-pocket cost for care.

All Charges