Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS

Facility

$11,121.44

Service Code	APR-DRG 8613
Min. Negotiated Rate	$10,903.37
Max. Negotiated Rate	$11,121.44
Rate for Payer: UnitedHealthcare Community & State	$10,903.37
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,121.44
Rate for Payer: Wellpoint Medicaid Managed Care	$10,903.37

SI JOINTS 3+ VIEWS

Facility

$5,100.00

Service Code	HCPCS 72202
Hospital Charge Code	94061099
Hospital Revenue Code	320
Min. Negotiated Rate	$38.72
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$86.94
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
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	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$316.08
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

SI JOINTS 3+ VIEWS

Facility

$5,100.00

Service Code	HCPCS 72202
Hospital Charge Code	94061099
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

SILDENAFIL 10MG (HALF TAB)

Facility

$141.17

Service Code	HCPCS S0090
Hospital Charge Code	606390401
Hospital Revenue Code	636
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$70.58
Rate for Payer: Aetna Commercial	$53.64
Rate for Payer: Aetna Medicare Advantage	$42.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.00
Rate for Payer: Cigna Commercial	$70.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.16
Rate for Payer: Qualcare PPO/HMO/WC	$21.18
Rate for Payer: UnitedHealthcare Community & State	$3.40
Rate for Payer: Wellpoint Medicaid Managed Care	$3.74

SILDENAFIL 10MG (HALF TAB)

Facility

$141.17

Service Code	HCPCS S0090
Hospital Charge Code	606390401
Hospital Revenue Code	636
Min. Negotiated Rate	$21.18
Max. Negotiated Rate	$34.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.16
Rate for Payer: Qualcare PPO/HMO/WC	$21.18

SILDENAFIL CITRATE 20 MG TAB

Facility

$141.17

Service Code	NDC 13668018505
Hospital Charge Code	60630054
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$70.58
Rate for Payer: Aetna Commercial	$53.64
Rate for Payer: Aetna Medicare Advantage	$42.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.00
Rate for Payer: Cigna Commercial	$70.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.35
Rate for Payer: Oxford Commercial	$28.23
Rate for Payer: Qualcare PPO/HMO/WC	$21.18
Rate for Payer: UnitedHealthcare Commercial	$28.23
Rate for Payer: UnitedHealthcare Community & State	$3.40
Rate for Payer: Wellpoint Medicaid Managed Care	$3.74

SILDENAFIL CITRATE 20 MG TAB

Facility

$141.17

Service Code	NDC 13668018505
Hospital Charge Code	60630054
Hospital Revenue Code	250
Min. Negotiated Rate	$21.18
Max. Negotiated Rate	$21.18
Rate for Payer: Qualcare PPO/HMO/WC	$21.18

SILICONE TUBING SET

Facility

$235.00

Hospital Charge Code	270332544
Hospital Revenue Code	272
Min. Negotiated Rate	$35.25
Max. Negotiated Rate	$35.25
Rate for Payer: Qualcare PPO/HMO/WC	$35.25

SILICONE TUBING SET

Facility

$235.00

Hospital Charge Code	270332544
Hospital Revenue Code	272
Min. Negotiated Rate	$5.66
Max. Negotiated Rate	$117.50
Rate for Payer: Aetna Commercial	$89.30
Rate for Payer: Aetna Medicare Advantage	$70.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.92
Rate for Payer: Cigna Commercial	$117.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.50
Rate for Payer: Oxford Commercial	$47.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.25
Rate for Payer: UnitedHealthcare Commercial	$47.00
Rate for Payer: UnitedHealthcare Community & State	$5.66
Rate for Payer: Wellpoint Medicaid Managed Care	$6.23

SILSPORT W/CANNULA 5-12MM

Facility

$3,041.04

Hospital Charge Code	270664790
Hospital Revenue Code	272
Min. Negotiated Rate	$456.16
Max. Negotiated Rate	$456.16
Rate for Payer: Qualcare PPO/HMO/WC	$456.16

SILSPORT W/CANNULA 5-12MM

Facility

$3,041.04

Hospital Charge Code	270664790
Hospital Revenue Code	272
Min. Negotiated Rate	$73.29
Max. Negotiated Rate	$1,520.52
Rate for Payer: Aetna Commercial	$1,155.60
Rate for Payer: Aetna Medicare Advantage	$912.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$775.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$775.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$775.47
Rate for Payer: Cigna Commercial	$1,520.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$912.31
Rate for Payer: Oxford Commercial	$608.21
Rate for Payer: Qualcare PPO/HMO/WC	$456.16
Rate for Payer: UnitedHealthcare Commercial	$608.21
Rate for Payer: UnitedHealthcare Community & State	$73.29
Rate for Payer: Wellpoint Medicaid Managed Care	$80.59

SI LUTION SCREW 12X45MM

Facility

$15,625.00

Hospital Charge Code	270702341
Hospital Revenue Code	278
Min. Negotiated Rate	$376.56
Max. Negotiated Rate	$7,812.50
Rate for Payer: Aetna Commercial	$5,937.50
Rate for Payer: Aetna Medicare Advantage	$4,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,984.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,984.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,984.38
Rate for Payer: Cigna Commercial	$7,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,781.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,437.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,343.75
Rate for Payer: UnitedHealthcare Community & State	$376.56
Rate for Payer: Wellpoint Medicaid Managed Care	$414.06

SI LUTION SCREW 12X45MM

Facility

$15,625.00

Hospital Charge Code	270702341
Hospital Revenue Code	278
Min. Negotiated Rate	$2,343.75
Max. Negotiated Rate	$3,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,781.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,437.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,343.75

SILVADENE 1%/20GM

Facility

$24.00

Hospital Charge Code	60633878
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna Commercial	$9.12
Rate for Payer: Aetna Medicare Advantage	$7.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.12
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.20
Rate for Payer: Oxford Commercial	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$3.60
Rate for Payer: UnitedHealthcare Commercial	$4.80
Rate for Payer: UnitedHealthcare Community & State	$0.58
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

SILVADENE 1%/20GM

Facility

$24.00

Hospital Charge Code	60633878
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.60

SILVADENE 1%/400GM

Facility

$150.00

Hospital Charge Code	60633879
Hospital Revenue Code	250
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.00
Rate for Payer: Oxford Commercial	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$30.00
Rate for Payer: UnitedHealthcare Community & State	$3.62
Rate for Payer: Wellpoint Medicaid Managed Care	$3.98

SILVADENE 1%/400GM

Facility

$150.00

Hospital Charge Code	60633879
Hospital Revenue Code	250
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

SILVADINE CREAM 20 GM

Facility

$13.20

Hospital Charge Code	60628363W
Hospital Revenue Code	250
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$1.98
Rate for Payer: Qualcare PPO/HMO/WC	$1.98

SILVADINE CREAM 20 GM

Facility

$13.20

Hospital Charge Code	60628363W
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$6.60
Rate for Payer: Aetna Commercial	$5.02
Rate for Payer: Aetna Medicare Advantage	$3.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.37
Rate for Payer: Cigna Commercial	$6.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.96
Rate for Payer: Oxford Commercial	$2.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.98
Rate for Payer: UnitedHealthcare Commercial	$2.64
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.35

SILVASORB 1.5OZ

Facility

$111.00

Hospital Charge Code	60635554
Hospital Revenue Code	250
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.65

SILVASORB 1.5OZ

Facility

$111.00

Hospital Charge Code	60635554
Hospital Revenue Code	250
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$55.50
Rate for Payer: Aetna Commercial	$42.18
Rate for Payer: Aetna Medicare Advantage	$33.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.30
Rate for Payer: Cigna Commercial	$55.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.30
Rate for Payer: Oxford Commercial	$22.20
Rate for Payer: Qualcare PPO/HMO/WC	$16.65
Rate for Payer: UnitedHealthcare Commercial	$22.20
Rate for Payer: UnitedHealthcare Community & State	$2.68
Rate for Payer: Wellpoint Medicaid Managed Care	$2.94

SILVASORB HYDGEL 1.5 MSC9301EP

Facility

$72.01

Hospital Charge Code	270640870W
Hospital Revenue Code	272
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$36.01
Rate for Payer: Aetna Commercial	$27.36
Rate for Payer: Aetna Medicare Advantage	$21.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.36
Rate for Payer: Cigna Commercial	$36.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.60
Rate for Payer: Oxford Commercial	$14.40
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$14.40
Rate for Payer: UnitedHealthcare Community & State	$1.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1.91

SILVASORB HYDGEL 1.5 MSC9301EP

Facility

$72.01

Hospital Charge Code	270640870W
Hospital Revenue Code	272
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

SILVASORB WOUND GEL

Facility

$4.00

Service Code	NDC 8327030906
Hospital Charge Code	606361037
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SILVASORB WOUND GEL

Facility

$4.00

Service Code	NDC 8327030906
Hospital Charge Code	606361037
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

Know your out-of-pocket cost for care.

All Charges