Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SAPHENOUS VEIN #VTS03151101B

Facility

$24,000.00

Hospital Charge Code	270656768
Hospital Revenue Code	278
Min. Negotiated Rate	$3,600.00
Max. Negotiated Rate	$5,808.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,800.00
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

SAQUINAVIR MESYLATE 200 MG CAP

Facility

$30.62

Service Code	NDC 4024515
Hospital Charge Code	60629027
Hospital Revenue Code	250
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$4.59
Rate for Payer: Qualcare PPO/HMO/WC	$4.59

SAQUINAVIR MESYLATE 200 MG CAP

Facility

$30.62

Service Code	NDC 4024515
Hospital Charge Code	60629027
Hospital Revenue Code	250
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$15.31
Rate for Payer: Aetna Commercial	$11.64
Rate for Payer: Aetna Medicare Advantage	$9.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.81
Rate for Payer: Cigna Commercial	$15.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.19
Rate for Payer: Oxford Commercial	$6.12
Rate for Payer: Qualcare PPO/HMO/WC	$4.59
Rate for Payer: UnitedHealthcare Commercial	$6.12
Rate for Payer: UnitedHealthcare Community & State	$0.74
Rate for Payer: Wellpoint Medicaid Managed Care	$0.81

SARAN ROLL *************

Facility

$168.00

Hospital Charge Code	8001646
Hospital Revenue Code	279
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$25.20
Rate for Payer: Qualcare PPO/HMO/WC	$25.20

SARAN ROLL *************

Facility

$168.00

Hospital Charge Code	8001646
Hospital Revenue Code	279
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$84.00
Rate for Payer: Aetna Commercial	$63.84
Rate for Payer: Aetna Medicare Advantage	$50.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.84
Rate for Payer: Cigna Commercial	$84.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.40
Rate for Payer: Oxford Commercial	$33.60
Rate for Payer: Qualcare PPO/HMO/WC	$25.20
Rate for Payer: UnitedHealthcare Commercial	$33.60
Rate for Payer: UnitedHealthcare Community & State	$4.05
Rate for Payer: Wellpoint Medicaid Managed Care	$4.45

SARGRAMOSTIM INJ 250MCG

Facility

$485.80

Hospital Charge Code	6016299
Hospital Revenue Code	636
Min. Negotiated Rate	$72.87
Max. Negotiated Rate	$117.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.56
Rate for Payer: Qualcare PPO/HMO/WC	$72.87

SARGRAMOSTIM INJ 250MCG

Facility

$485.80

Hospital Charge Code	6016299
Hospital Revenue Code	636
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$242.90
Rate for Payer: Aetna Commercial	$184.60
Rate for Payer: Aetna Medicare Advantage	$145.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$123.88
Rate for Payer: Cigna Commercial	$242.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.56
Rate for Payer: Qualcare PPO/HMO/WC	$72.87
Rate for Payer: UnitedHealthcare Community & State	$11.71
Rate for Payer: Wellpoint Medicaid Managed Care	$12.87

SARGRAMOSTIM INJ 500MCG

Facility

$910.75

Hospital Charge Code	6016281
Hospital Revenue Code	636
Min. Negotiated Rate	$21.95
Max. Negotiated Rate	$455.38
Rate for Payer: Aetna Commercial	$346.08
Rate for Payer: Aetna Medicare Advantage	$273.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$232.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$232.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$232.24
Rate for Payer: Cigna Commercial	$455.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$220.40
Rate for Payer: Qualcare PPO/HMO/WC	$136.61
Rate for Payer: UnitedHealthcare Community & State	$21.95
Rate for Payer: Wellpoint Medicaid Managed Care	$24.13

SARGRAMOSTIM INJ 500MCG

Facility

$910.75

Hospital Charge Code	6016281
Hospital Revenue Code	636
Min. Negotiated Rate	$136.61
Max. Negotiated Rate	$220.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$220.40
Rate for Payer: Qualcare PPO/HMO/WC	$136.61

SARGRAMOSTIM INJ 50MCG

Facility

$95.40

Hospital Charge Code	6017123
Hospital Revenue Code	636
Min. Negotiated Rate	$14.31
Max. Negotiated Rate	$23.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.09
Rate for Payer: Qualcare PPO/HMO/WC	$14.31

SARGRAMOSTIM INJ 50MCG

Facility

$95.40

Hospital Charge Code	6017123
Hospital Revenue Code	636
Min. Negotiated Rate	$2.30
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna Commercial	$36.25
Rate for Payer: Aetna Medicare Advantage	$28.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.33
Rate for Payer: Cigna Commercial	$47.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.09
Rate for Payer: Qualcare PPO/HMO/WC	$14.31
Rate for Payer: UnitedHealthcare Community & State	$2.30
Rate for Payer: Wellpoint Medicaid Managed Care	$2.53

SARGRAMOSTIM IVPB 500MG/ML

Facility

$1,728.00

Hospital Charge Code	60628954
Hospital Revenue Code	636
Min. Negotiated Rate	$259.20
Max. Negotiated Rate	$418.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$418.18
Rate for Payer: Qualcare PPO/HMO/WC	$259.20

SARGRAMOSTIM IVPB 500MG/ML

Facility

$1,728.00

Hospital Charge Code	60628954
Hospital Revenue Code	636
Min. Negotiated Rate	$41.64
Max. Negotiated Rate	$864.00
Rate for Payer: Aetna Commercial	$656.64
Rate for Payer: Aetna Medicare Advantage	$518.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$440.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$440.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$440.64
Rate for Payer: Cigna Commercial	$864.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$418.18
Rate for Payer: Qualcare PPO/HMO/WC	$259.20
Rate for Payer: UnitedHealthcare Community & State	$41.64
Rate for Payer: Wellpoint Medicaid Managed Care	$45.79

SAROFLOXAIN INJ 250MG/50ML

Facility

$136.35

Hospital Charge Code	6017917
Hospital Revenue Code	250
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$68.17
Rate for Payer: Aetna Commercial	$51.81
Rate for Payer: Aetna Medicare Advantage	$40.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.77
Rate for Payer: Cigna Commercial	$68.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.91
Rate for Payer: Oxford Commercial	$27.27
Rate for Payer: Qualcare PPO/HMO/WC	$20.45
Rate for Payer: UnitedHealthcare Commercial	$27.27
Rate for Payer: UnitedHealthcare Community & State	$3.29
Rate for Payer: Wellpoint Medicaid Managed Care	$3.61

SAROFLOXAIN INJ 250MG/50ML

Facility

$136.35

Hospital Charge Code	6017917
Hospital Revenue Code	250
Min. Negotiated Rate	$20.45
Max. Negotiated Rate	$20.45
Rate for Payer: Qualcare PPO/HMO/WC	$20.45

SARS-COV-2 COVID-19 ANTIBODY

Facility

$387.00

Service Code	HCPCS 86769
Hospital Charge Code	401386769
Hospital Revenue Code	302
Min. Negotiated Rate	$10.26
Max. Negotiated Rate	$193.50
Rate for Payer: Aetna Commercial	$114.59
Rate for Payer: Aetna Medicare Advantage	$136.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$42.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.08
Rate for Payer: Cigna Commercial	$193.50
Rate for Payer: Cigna Medicare Advantage	$42.13
Rate for Payer: Clover Medicare Advantage	$40.02
Rate for Payer: EmblemHealth Commercial	$126.39
Rate for Payer: Humana Medicare Advantage	$43.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$42.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$33.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.13
Rate for Payer: Wellcare Medicare Advantage	$42.13
Rate for Payer: Wellpoint Medicaid Managed Care	$10.26

SARS-COV-2 COVID-19 ANTIBODY

Facility

$387.00

Service Code	HCPCS 86769
Hospital Charge Code	401386769
Hospital Revenue Code	302
Min. Negotiated Rate	$58.05
Max. Negotiated Rate	$58.05
Rate for Payer: Qualcare PPO/HMO/WC	$58.05

SARSCO V2 &INFO AB RSV AMP PRB

Facility

$1,400.00

Service Code	HCPCS 87637
Hospital Charge Code	4013878044
Hospital Revenue Code	306
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$210.00
Rate for Payer: Qualcare PPO/HMO/WC	$210.00

SARSCO V2 &INFO AB RSV AMP PRB

Facility

$1,400.00

Service Code	HCPCS 87637
Hospital Charge Code	4013878044
Hospital Revenue Code	306
Min. Negotiated Rate	$37.10
Max. Negotiated Rate	$700.00
Rate for Payer: Aetna Commercial	$387.95
Rate for Payer: Aetna Medicare Advantage	$462.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$514.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$514.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$142.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$276.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$514.85
Rate for Payer: Cigna Commercial	$700.00
Rate for Payer: Cigna Medicare Advantage	$142.63
Rate for Payer: Clover Medicare Advantage	$135.50
Rate for Payer: EmblemHealth Commercial	$427.89
Rate for Payer: Humana Medicare Advantage	$146.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$142.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$420.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$210.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$114.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$142.63
Rate for Payer: Wellcare Medicare Advantage	$142.63
Rate for Payer: Wellpoint Medicaid Managed Care	$37.10

SARSCOV2NUCLEOCAPIGMSPIKEQL

Facility

$210.65

Service Code	HCPCS 86769
Hospital Charge Code	401386769D
Hospital Revenue Code	302
Min. Negotiated Rate	$5.58
Max. Negotiated Rate	$152.08
Rate for Payer: Aetna Commercial	$114.59
Rate for Payer: Aetna Medicare Advantage	$136.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$42.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.08
Rate for Payer: Cigna Commercial	$105.33
Rate for Payer: Cigna Medicare Advantage	$42.13
Rate for Payer: Clover Medicare Advantage	$40.02
Rate for Payer: EmblemHealth Commercial	$126.39
Rate for Payer: Humana Medicare Advantage	$43.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$42.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$33.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.13
Rate for Payer: Wellcare Medicare Advantage	$42.13
Rate for Payer: Wellpoint Medicaid Managed Care	$5.58

SARSCOV2NUCLEOCAPIGMSPIKEQL

Facility

$210.65

Service Code	HCPCS 86769
Hospital Charge Code	401386769D
Hospital Revenue Code	302
Min. Negotiated Rate	$31.60
Max. Negotiated Rate	$31.60
Rate for Payer: Qualcare PPO/HMO/WC	$31.60

SARS-COV-2 RNA PCR COVID19 QUE

Facility

$345.00

Service Code	HCPCS 87798
Hospital Charge Code	401387798
Hospital Revenue Code	306
Min. Negotiated Rate	$9.14
Max. Negotiated Rate	$172.50
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$153.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$172.50
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$9.14

SARS-COV-2 RNA PCR COVID19 QUE

Facility

$345.00

Service Code	HCPCS 87798
Hospital Charge Code	401387798
Hospital Revenue Code	306
Min. Negotiated Rate	$51.75
Max. Negotiated Rate	$51.75
Rate for Payer: Qualcare PPO/HMO/WC	$51.75

SATURATE MIXING SYSTEM

Facility

$126.83

Hospital Charge Code	270670677
Hospital Revenue Code	272
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$63.41
Rate for Payer: Aetna Commercial	$48.20
Rate for Payer: Aetna Medicare Advantage	$38.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.34
Rate for Payer: Cigna Commercial	$63.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.05
Rate for Payer: Oxford Commercial	$25.37
Rate for Payer: Qualcare PPO/HMO/WC	$19.02
Rate for Payer: UnitedHealthcare Commercial	$25.37
Rate for Payer: UnitedHealthcare Community & State	$3.06
Rate for Payer: Wellpoint Medicaid Managed Care	$3.36

SATURATE MIXING SYSTEM

Facility

$126.83

Hospital Charge Code	270670677
Hospital Revenue Code	272
Min. Negotiated Rate	$19.02
Max. Negotiated Rate	$19.02
Rate for Payer: Qualcare PPO/HMO/WC	$19.02

Know your out-of-pocket cost for care.

All Charges