Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SAGITTAL BLADE 25.0 X 1.27 X 9

Facility

$300.00

Hospital Charge Code	270650287
Hospital Revenue Code	272
Min. Negotiated Rate	$7.23
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.00
Rate for Payer: Oxford Commercial	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Commercial	$60.00
Rate for Payer: UnitedHealthcare Community & State	$7.23
Rate for Payer: Wellpoint Medicaid Managed Care	$7.95

SAGITTAL BLADE 25MMX95MMX1.2MM

Facility

$265.00

Hospital Charge Code	270660097
Hospital Revenue Code	272
Min. Negotiated Rate	$6.39
Max. Negotiated Rate	$132.50
Rate for Payer: Aetna Commercial	$100.70
Rate for Payer: Aetna Medicare Advantage	$79.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.58
Rate for Payer: Cigna Commercial	$132.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.50
Rate for Payer: Oxford Commercial	$53.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.75
Rate for Payer: UnitedHealthcare Commercial	$53.00
Rate for Payer: UnitedHealthcare Community & State	$6.39
Rate for Payer: Wellpoint Medicaid Managed Care	$7.02

SAGITTAL BLADE 25MMX95MMX1.2MM

Facility

$265.00

Hospital Charge Code	270660097
Hospital Revenue Code	272
Min. Negotiated Rate	$39.75
Max. Negotiated Rate	$39.75
Rate for Payer: Qualcare PPO/HMO/WC	$39.75

SAGITTAL SAW ATTACHMENT

Facility

$9,924.00

Hospital Charge Code	270674163
Hospital Revenue Code	272
Min. Negotiated Rate	$239.17
Max. Negotiated Rate	$4,962.00
Rate for Payer: Aetna Commercial	$3,771.12
Rate for Payer: Aetna Medicare Advantage	$2,977.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,530.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,530.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,530.62
Rate for Payer: Cigna Commercial	$4,962.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,977.20
Rate for Payer: Oxford Commercial	$1,984.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,488.60
Rate for Payer: UnitedHealthcare Commercial	$1,984.80
Rate for Payer: UnitedHealthcare Community & State	$239.17
Rate for Payer: Wellpoint Medicaid Managed Care	$262.99

SAGITTAL SAW ATTACHMENT

Facility

$9,924.00

Hospital Charge Code	270674163
Hospital Revenue Code	272
Min. Negotiated Rate	$1,488.60
Max. Negotiated Rate	$1,488.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,488.60

SALICYLATE, BLOOD (ASPIRIN)

Facility

$667.59

Service Code	HCPCS 80329
Hospital Charge Code	3002391
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

SALICYLATE, BLOOD (ASPIRIN)

Facility

$667.59

Service Code	HCPCS 80329
Hospital Charge Code	3002391
Hospital Revenue Code	301
Min. Negotiated Rate	$16.48
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$253.68
Rate for Payer: Aetna Medicare Advantage	$200.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.24
Rate for Payer: Cigna Commercial	$333.80
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	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

SALICYLATE,SERUM

Facility

$226.00

Service Code	HCPCS 80329
Hospital Charge Code	38472602
Hospital Revenue Code	301
Min. Negotiated Rate	$5.99
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$85.88
Rate for Payer: Aetna Medicare Advantage	$67.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.63
Rate for Payer: Cigna Commercial	$113.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$5.99

SALICYLATE,SERUM

Facility

$226.00

Service Code	HCPCS 80329
Hospital Charge Code	38472602
Hospital Revenue Code	301
Min. Negotiated Rate	$33.90
Max. Negotiated Rate	$33.90
Rate for Payer: Qualcare PPO/HMO/WC	$33.90

SALICYLIC ACID 2% SHAMPOO

Facility

$74.45

Hospital Charge Code	60628435
Hospital Revenue Code	250
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$37.23
Rate for Payer: Aetna Commercial	$28.29
Rate for Payer: Aetna Medicare Advantage	$22.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.98
Rate for Payer: Cigna Commercial	$37.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.34
Rate for Payer: Oxford Commercial	$14.89
Rate for Payer: Qualcare PPO/HMO/WC	$11.17
Rate for Payer: UnitedHealthcare Commercial	$14.89
Rate for Payer: UnitedHealthcare Community & State	$1.79
Rate for Payer: Wellpoint Medicaid Managed Care	$1.97

SALICYLIC ACID 2% SHAMPOO

Facility

$74.45

Hospital Charge Code	60628435
Hospital Revenue Code	250
Min. Negotiated Rate	$11.17
Max. Negotiated Rate	$11.17
Rate for Payer: Qualcare PPO/HMO/WC	$11.17

SALINE 9 UNIT DOSE 15 ML

Facility

$0.82

Hospital Charge Code	270632373
Hospital Revenue Code	270
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.12
Rate for Payer: Qualcare PPO/HMO/WC	$0.12

SALINE 9 UNIT DOSE 15 ML

Facility

$0.82

Hospital Charge Code	270632373
Hospital Revenue Code	270
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.41
Rate for Payer: Aetna Commercial	$0.31
Rate for Payer: Aetna Medicare Advantage	$0.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.21
Rate for Payer: Cigna Commercial	$0.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.25
Rate for Payer: Oxford Commercial	$0.16
Rate for Payer: Qualcare PPO/HMO/WC	$0.12
Rate for Payer: UnitedHealthcare Commercial	$0.16
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.02

SALINE BAGS VITEK XL

Facility

$36.95

Hospital Charge Code	270667524
Hospital Revenue Code	270
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$18.48
Rate for Payer: Aetna Commercial	$14.04
Rate for Payer: Aetna Medicare Advantage	$11.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.42
Rate for Payer: Cigna Commercial	$18.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.09
Rate for Payer: Oxford Commercial	$7.39
Rate for Payer: Qualcare PPO/HMO/WC	$5.54
Rate for Payer: UnitedHealthcare Commercial	$7.39
Rate for Payer: UnitedHealthcare Community & State	$0.89
Rate for Payer: Wellpoint Medicaid Managed Care	$0.98

SALINE BAGS VITEK XL

Facility

$36.95

Hospital Charge Code	270667524
Hospital Revenue Code	270
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$5.54
Rate for Payer: Qualcare PPO/HMO/WC	$5.54

SALIVARY GLAND PROCEDURES

Facility

$42,074.01

Service Code	MSDRG 139
Min. Negotiated Rate	$12,811.00
Max. Negotiated Rate	$42,074.01
Rate for Payer: Aetna Commercial	$29,166.96
Rate for Payer: Aetna Medicare Advantage	$42,074.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27,680.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27,680.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,485.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27,680.59
Rate for Payer: Cigna Commercial	$22,617.74
Rate for Payer: Cigna Medicare Advantage	$13,485.26
Rate for Payer: Clover Medicare Advantage	$12,811.00
Rate for Payer: EmblemHealth Commercial	$40,455.78
Rate for Payer: Humana Medicare Advantage	$13,889.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,485.26
Rate for Payer: Oxford Commercial	$16,255.67
Rate for Payer: UnitedHealthcare Commercial	$28,504.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,485.26
Rate for Payer: Wellcare Medicare Advantage	$13,485.26

SALIVA SUBSTITUTE/120ML

Facility

$90.45

Service Code	NDC 50930009808
Hospital Charge Code	60634632
Hospital Revenue Code	250
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$45.23
Rate for Payer: Aetna Commercial	$34.37
Rate for Payer: Aetna Medicare Advantage	$27.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.06
Rate for Payer: Cigna Commercial	$45.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.14
Rate for Payer: Oxford Commercial	$18.09
Rate for Payer: Qualcare PPO/HMO/WC	$13.57
Rate for Payer: UnitedHealthcare Commercial	$18.09
Rate for Payer: UnitedHealthcare Community & State	$2.18
Rate for Payer: Wellpoint Medicaid Managed Care	$2.40

SALIVA SUBSTITUTE/120ML

Facility

$90.45

Service Code	NDC 50930009808
Hospital Charge Code	60634632
Hospital Revenue Code	250
Min. Negotiated Rate	$13.57
Max. Negotiated Rate	$13.57
Rate for Payer: Qualcare PPO/HMO/WC	$13.57

SALIVA SUBSTITUTES - ORAL SOLN

Facility

$46.45

Hospital Charge Code	60628455
Hospital Revenue Code	250
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$23.23
Rate for Payer: Aetna Commercial	$17.65
Rate for Payer: Aetna Medicare Advantage	$13.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.84
Rate for Payer: Cigna Commercial	$23.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.94
Rate for Payer: Oxford Commercial	$9.29
Rate for Payer: Qualcare PPO/HMO/WC	$6.97
Rate for Payer: UnitedHealthcare Commercial	$9.29
Rate for Payer: UnitedHealthcare Community & State	$1.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1.23

SALIVA SUBSTITUTES - ORAL SOLN

Facility

$46.45

Hospital Charge Code	60628455
Hospital Revenue Code	250
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$6.97
Rate for Payer: Qualcare PPO/HMO/WC	$6.97

SALIVA SUBSTITUTION COMBO

Facility

$23.86

Hospital Charge Code	606350909
Hospital Revenue Code	250
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$3.58
Rate for Payer: Qualcare PPO/HMO/WC	$3.58

SALIVA SUBSTITUTION COMBO

Facility

$23.86

Hospital Charge Code	606350909
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$11.93
Rate for Payer: Aetna Commercial	$9.07
Rate for Payer: Aetna Medicare Advantage	$7.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.08
Rate for Payer: Cigna Commercial	$11.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.16
Rate for Payer: Oxford Commercial	$4.77
Rate for Payer: Qualcare PPO/HMO/WC	$3.58
Rate for Payer: UnitedHealthcare Commercial	$4.77
Rate for Payer: UnitedHealthcare Community & State	$0.58
Rate for Payer: Wellpoint Medicaid Managed Care	$0.63

SALMETEROL 21MCG AEROSOL

Facility

$270.75

Hospital Charge Code	60627469
Hospital Revenue Code	252
Min. Negotiated Rate	$6.53
Max. Negotiated Rate	$135.38
Rate for Payer: Aetna Commercial	$102.89
Rate for Payer: Aetna Medicare Advantage	$81.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.04
Rate for Payer: Cigna Commercial	$135.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.22
Rate for Payer: Oxford Commercial	$54.15
Rate for Payer: Qualcare PPO/HMO/WC	$40.61
Rate for Payer: UnitedHealthcare Commercial	$54.15
Rate for Payer: UnitedHealthcare Community & State	$6.53
Rate for Payer: Wellpoint Medicaid Managed Care	$7.17

SALMETEROL 21MCG AEROSOL

Facility

$270.75

Hospital Charge Code	60627469
Hospital Revenue Code	252
Min. Negotiated Rate	$40.61
Max. Negotiated Rate	$40.61
Rate for Payer: Qualcare PPO/HMO/WC	$40.61

SALMETEROL INHALER

Facility

$336.00

Hospital Charge Code	6016471
Hospital Revenue Code	252
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$50.40
Rate for Payer: Qualcare PPO/HMO/WC	$50.40

Know your out-of-pocket cost for care.

All Charges