Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SALUTENSIN 50/0.125/TAB

Facility

$6.00

Hospital Charge Code	60633855
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

SALUTENSIN 50/0.125/TAB

Facility

$6.00

Hospital Charge Code	60633855
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

SAME DAY SURG EA ADD 30 MIN

Facility

$2,548.00

Hospital Charge Code	100042
Hospital Revenue Code	360
Min. Negotiated Rate	$61.41
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$968.24
Rate for Payer: Aetna Medicare Advantage	$764.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$649.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$649.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$649.74
Rate for Payer: Cigna Commercial	$1,274.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$764.40
Rate for Payer: Qualcare PPO/HMO/WC	$382.20
Rate for Payer: UnitedHealthcare Community & State	$61.41
Rate for Payer: Wellpoint Medicaid Managed Care	$67.52

SAME DAY SURG EA ADD 30 MIN

Facility

$2,548.00

Hospital Charge Code	100042
Hospital Revenue Code	360
Min. Negotiated Rate	$382.20
Max. Negotiated Rate	$382.20
Rate for Payer: Qualcare PPO/HMO/WC	$382.20

SAME DAY SURGERY CHARGE

Facility

$4,950.47

Hospital Charge Code	100040
Hospital Revenue Code	499
Min. Negotiated Rate	$119.31
Max. Negotiated Rate	$2,475.24
Rate for Payer: Aetna Commercial	$1,881.18
Rate for Payer: Aetna Medicare Advantage	$1,485.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,262.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,262.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,262.37
Rate for Payer: Cigna Commercial	$2,475.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,485.14
Rate for Payer: Qualcare PPO/HMO/WC	$742.57
Rate for Payer: UnitedHealthcare Community & State	$119.31
Rate for Payer: Wellpoint Medicaid Managed Care	$131.19

SAME DAY SURGERY CHARGE

Facility

$4,950.47

Hospital Charge Code	100040
Hospital Revenue Code	499
Min. Negotiated Rate	$742.57
Max. Negotiated Rate	$742.57
Rate for Payer: Qualcare PPO/HMO/WC	$742.57

SAMPLE LINE 2.3 M GAS ADULT

Facility

$45.74

Hospital Charge Code	270683949
Hospital Revenue Code	272
Min. Negotiated Rate	$6.86
Max. Negotiated Rate	$6.86
Rate for Payer: Qualcare PPO/HMO/WC	$6.86

SAMPLE LINE 2.3 M GAS ADULT

Facility

$45.74

Hospital Charge Code	270683949
Hospital Revenue Code	272
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$22.87
Rate for Payer: Aetna Commercial	$17.38
Rate for Payer: Aetna Medicare Advantage	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.66
Rate for Payer: Cigna Commercial	$22.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.72
Rate for Payer: Oxford Commercial	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$6.86
Rate for Payer: UnitedHealthcare Commercial	$9.15
Rate for Payer: UnitedHealthcare Community & State	$1.10
Rate for Payer: Wellpoint Medicaid Managed Care	$1.21

SAMPLE PORT HME SMALL

Facility

$5.35

Hospital Charge Code	270637629
Hospital Revenue Code	272
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.80

SAMPLE PORT HME SMALL

Facility

$5.35

Hospital Charge Code	270637629
Hospital Revenue Code	272
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.67
Rate for Payer: Aetna Commercial	$2.03
Rate for Payer: Aetna Medicare Advantage	$1.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.36
Rate for Payer: Cigna Commercial	$2.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.60
Rate for Payer: Oxford Commercial	$1.07
Rate for Payer: Qualcare PPO/HMO/WC	$0.80
Rate for Payer: UnitedHealthcare Commercial	$1.07
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

SAMPLING PORT*****

Facility

$9.00

Hospital Charge Code	8002644
Hospital Revenue Code	279
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

SAMPLING PORT*****

Facility

$9.00

Hospital Charge Code	8002644
Hospital Revenue Code	279
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

SAMURAI BLADE FULL RADIUS

Facility

$1,211.00

Hospital Charge Code	270680361
Hospital Revenue Code	272
Min. Negotiated Rate	$181.65
Max. Negotiated Rate	$181.65
Rate for Payer: Qualcare PPO/HMO/WC	$181.65

SAMURAI BLADE FULL RADIUS

Facility

$1,211.00

Hospital Charge Code	270680361
Hospital Revenue Code	272
Min. Negotiated Rate	$29.19
Max. Negotiated Rate	$605.50
Rate for Payer: Aetna Commercial	$460.18
Rate for Payer: Aetna Medicare Advantage	$363.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$308.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$308.81
Rate for Payer: Cigna Commercial	$605.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.30
Rate for Payer: Oxford Commercial	$242.20
Rate for Payer: Qualcare PPO/HMO/WC	$181.65
Rate for Payer: UnitedHealthcare Commercial	$242.20
Rate for Payer: UnitedHealthcare Community & State	$29.19
Rate for Payer: Wellpoint Medicaid Managed Care	$32.09

SANDIMMUNE/100MG/1ML

Facility

$1,478.00

Hospital Charge Code	60633856
Hospital Revenue Code	250
Min. Negotiated Rate	$35.62
Max. Negotiated Rate	$739.00
Rate for Payer: Aetna Commercial	$561.64
Rate for Payer: Aetna Medicare Advantage	$443.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.89
Rate for Payer: Cigna Commercial	$739.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$443.40
Rate for Payer: Oxford Commercial	$295.60
Rate for Payer: Qualcare PPO/HMO/WC	$221.70
Rate for Payer: UnitedHealthcare Commercial	$295.60
Rate for Payer: UnitedHealthcare Community & State	$35.62
Rate for Payer: Wellpoint Medicaid Managed Care	$39.17

SANDIMMUNE/100MG/1ML

Facility

$1,478.00

Hospital Charge Code	60633856
Hospital Revenue Code	250
Min. Negotiated Rate	$221.70
Max. Negotiated Rate	$221.70
Rate for Payer: Qualcare PPO/HMO/WC	$221.70

SANDIMMUNE CAPS 100MG

Facility

$26.00

Hospital Charge Code	60635002
Hospital Revenue Code	250
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$3.90
Rate for Payer: Qualcare PPO/HMO/WC	$3.90

SANDIMMUNE CAPS 100MG

Facility

$26.00

Hospital Charge Code	60635002
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$13.00
Rate for Payer: Aetna Commercial	$9.88
Rate for Payer: Aetna Medicare Advantage	$7.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.63
Rate for Payer: Cigna Commercial	$13.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.80
Rate for Payer: Oxford Commercial	$5.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.90
Rate for Payer: UnitedHealthcare Commercial	$5.20
Rate for Payer: UnitedHealthcare Community & State	$0.63
Rate for Payer: Wellpoint Medicaid Managed Care	$0.69

SANDOSTATIN 5000MCG MDV

Facility

$4,214.00

Hospital Charge Code	60635516
Hospital Revenue Code	636
Min. Negotiated Rate	$101.56
Max. Negotiated Rate	$2,107.00
Rate for Payer: Aetna Commercial	$1,601.32
Rate for Payer: Aetna Medicare Advantage	$1,264.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,074.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,074.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,074.57
Rate for Payer: Cigna Commercial	$2,107.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,019.79
Rate for Payer: Qualcare PPO/HMO/WC	$632.10
Rate for Payer: UnitedHealthcare Community & State	$101.56
Rate for Payer: Wellpoint Medicaid Managed Care	$111.67

SANDOSTATIN 5000MCG MDV

Facility

$4,214.00

Hospital Charge Code	60635516
Hospital Revenue Code	636
Min. Negotiated Rate	$632.10
Max. Negotiated Rate	$1,019.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,019.79
Rate for Payer: Qualcare PPO/HMO/WC	$632.10

SANSERT/1MG/TAB

Facility

$3.00

Hospital Charge Code	60634395
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

SANSERT/1MG/TAB

Facility

$3.00

Hospital Charge Code	60634395
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SANTYL OINT 30 GMS

Facility

$140.00

Hospital Charge Code	60635223
Hospital Revenue Code	250
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00

SANTYL OINT 30 GMS

Facility

$140.00

Hospital Charge Code	60635223
Hospital Revenue Code	250
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$70.00
Rate for Payer: Aetna Commercial	$53.20
Rate for Payer: Aetna Medicare Advantage	$42.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.70
Rate for Payer: Cigna Commercial	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.00
Rate for Payer: Oxford Commercial	$28.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00
Rate for Payer: UnitedHealthcare Commercial	$28.00
Rate for Payer: UnitedHealthcare Community & State	$3.37
Rate for Payer: Wellpoint Medicaid Managed Care	$3.71

SAPHENOUS VEIN #VTS03151101B

Facility

$24,000.00

Hospital Charge Code	270656768
Hospital Revenue Code	278
Min. Negotiated Rate	$578.40
Max. Negotiated Rate	$12,000.00
Rate for Payer: Aetna Commercial	$9,120.00
Rate for Payer: Aetna Medicare Advantage	$7,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,120.00
Rate for Payer: Cigna Commercial	$12,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,808.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,280.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,600.00
Rate for Payer: UnitedHealthcare Community & State	$578.40
Rate for Payer: Wellpoint Medicaid Managed Care	$636.00

Know your out-of-pocket cost for care.

All Charges