Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SIMPLE PNEUMONIA AND PLEURISY WITH CC

Facility

$28,182.06

Service Code	MSDRG 194
Min. Negotiated Rate	$8,581.07
Max. Negotiated Rate	$28,182.06
Rate for Payer: Aetna Commercial	$19,621.63
Rate for Payer: Aetna Medicare Advantage	$28,182.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19,074.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19,074.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9,032.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19,074.02
Rate for Payer: Cigna Commercial	$15,081.61
Rate for Payer: Cigna Medicare Advantage	$9,032.71
Rate for Payer: Clover Medicare Advantage	$8,581.07
Rate for Payer: EmblemHealth Commercial	$27,098.13
Rate for Payer: Humana Medicare Advantage	$9,303.69
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9,032.71
Rate for Payer: Oxford Commercial	$10,839.35
Rate for Payer: UnitedHealthcare Commercial	$19,007.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$9,032.71
Rate for Payer: Wellcare Medicare Advantage	$9,032.71

SIMPLE PNEUMONIA AND PLEURISY WITH MCC

Facility

$44,617.65

Service Code	MSDRG 193
Min. Negotiated Rate	$13,585.50
Max. Negotiated Rate	$44,617.65
Rate for Payer: Aetna Commercial	$30,914.76
Rate for Payer: Aetna Medicare Advantage	$44,617.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30,937.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30,937.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14,300.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30,937.13
Rate for Payer: Cigna Commercial	$24,597.68
Rate for Payer: Cigna Medicare Advantage	$14,300.53
Rate for Payer: Clover Medicare Advantage	$13,585.50
Rate for Payer: EmblemHealth Commercial	$42,901.59
Rate for Payer: Humana Medicare Advantage	$14,729.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14,300.53
Rate for Payer: Oxford Commercial	$17,678.68
Rate for Payer: UnitedHealthcare Commercial	$31,000.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$14,300.53
Rate for Payer: Wellcare Medicare Advantage	$14,300.53

SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC

Facility

$22,448.21

Service Code	MSDRG 195
Min. Negotiated Rate	$6,835.19
Max. Negotiated Rate	$22,448.21
Rate for Payer: Aetna Commercial	$15,681.81
Rate for Payer: Aetna Medicare Advantage	$22,448.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,654.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,654.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,194.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,654.43
Rate for Payer: Cigna Commercial	$11,761.75
Rate for Payer: Cigna Medicare Advantage	$7,194.94
Rate for Payer: Clover Medicare Advantage	$6,835.19
Rate for Payer: EmblemHealth Commercial	$21,584.82
Rate for Payer: Humana Medicare Advantage	$7,410.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,194.94
Rate for Payer: Oxford Commercial	$8,453.33
Rate for Payer: UnitedHealthcare Commercial	$14,823.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,194.94
Rate for Payer: Wellcare Medicare Advantage	$7,194.94

SIMPLIFY DISC SIZE 1 HT 4

Facility

$26,991.25

Service Code	HCPCS C1713
Hospital Charge Code	270704796
Hospital Revenue Code	278
Min. Negotiated Rate	$4,048.69
Max. Negotiated Rate	$6,531.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,398.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,531.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,938.07
Rate for Payer: Qualcare PPO/HMO/WC	$4,048.69

SIMPLIFY DISC SIZE 1 HT 4

Facility

$26,991.25

Service Code	HCPCS C1713
Hospital Charge Code	270704796
Hospital Revenue Code	278
Min. Negotiated Rate	$650.49
Max. Negotiated Rate	$13,495.62
Rate for Payer: Aetna Commercial	$10,256.67
Rate for Payer: Aetna Medicare Advantage	$8,097.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,882.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,882.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,398.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,882.77
Rate for Payer: Cigna Commercial	$13,495.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,531.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,938.07
Rate for Payer: Qualcare PPO/HMO/WC	$4,048.69
Rate for Payer: UnitedHealthcare Community & State	$650.49
Rate for Payer: Wellpoint Medicaid Managed Care	$715.27

SIMPLIFY DISC SZ 1 HT 4

Facility

$57,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270695024
Hospital Revenue Code	278
Min. Negotiated Rate	$8,625.00
Max. Negotiated Rate	$13,915.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,915.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,625.00

SIMPLIFY DISC SZ 1 HT 4

Facility

$57,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270695024
Hospital Revenue Code	278
Min. Negotiated Rate	$1,385.75
Max. Negotiated Rate	$28,750.00
Rate for Payer: Aetna Commercial	$21,850.00
Rate for Payer: Aetna Medicare Advantage	$17,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,662.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,662.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,662.50
Rate for Payer: Cigna Commercial	$28,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,915.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,625.00
Rate for Payer: UnitedHealthcare Community & State	$1,385.75
Rate for Payer: Wellpoint Medicaid Managed Care	$1,523.75

SIMPLIFY DISC SZ 3 HT 5

Facility

$26,991.25

Service Code	HCPCS C1713
Hospital Charge Code	270703756
Hospital Revenue Code	278
Min. Negotiated Rate	$4,048.69
Max. Negotiated Rate	$6,531.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,398.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,531.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,938.07
Rate for Payer: Qualcare PPO/HMO/WC	$4,048.69

SIMPLIFY DISC SZ 3 HT 5

Facility

$26,991.25

Service Code	HCPCS C1713
Hospital Charge Code	270703756
Hospital Revenue Code	278
Min. Negotiated Rate	$650.49
Max. Negotiated Rate	$13,495.62
Rate for Payer: Aetna Commercial	$10,256.67
Rate for Payer: Aetna Medicare Advantage	$8,097.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,882.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,882.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,398.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,882.77
Rate for Payer: Cigna Commercial	$13,495.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,531.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,938.07
Rate for Payer: Qualcare PPO/HMO/WC	$4,048.69
Rate for Payer: UnitedHealthcare Community & State	$650.49
Rate for Payer: Wellpoint Medicaid Managed Care	$715.27

SIMPL SOLO SYST W/SHOW 0067700

Facility

$247.98

Hospital Charge Code	270640026
Hospital Revenue Code	272
Min. Negotiated Rate	$5.98
Max. Negotiated Rate	$123.99
Rate for Payer: Aetna Commercial	$94.23
Rate for Payer: Aetna Medicare Advantage	$74.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.23
Rate for Payer: Cigna Commercial	$123.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.39
Rate for Payer: Oxford Commercial	$49.60
Rate for Payer: Qualcare PPO/HMO/WC	$37.20
Rate for Payer: UnitedHealthcare Commercial	$49.60
Rate for Payer: UnitedHealthcare Community & State	$5.98
Rate for Payer: Wellpoint Medicaid Managed Care	$6.57

SIMPL SOLO SYST W/SHOW 0067700

Facility

$247.98

Hospital Charge Code	270640026
Hospital Revenue Code	272
Min. Negotiated Rate	$37.20
Max. Negotiated Rate	$37.20
Rate for Payer: Qualcare PPO/HMO/WC	$37.20

SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT

Facility

$183,283.96

Service Code	MSDRG 008
Min. Negotiated Rate	$55,807.62
Max. Negotiated Rate	$183,283.96
Rate for Payer: Aetna Medicare Advantage	$183,283.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122,352.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122,352.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$58,744.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122,352.86
Rate for Payer: Cigna Commercial	$104,884.48
Rate for Payer: Cigna Medicare Advantage	$58,744.86
Rate for Payer: Clover Medicare Advantage	$55,807.62
Rate for Payer: EmblemHealth Commercial	$176,234.58
Rate for Payer: Humana Medicare Advantage	$60,507.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$58,744.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$58,744.86
Rate for Payer: Wellcare Medicare Advantage	$58,744.86

SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS

Facility

$232,736.09

Service Code	MSDRG 019
Min. Negotiated Rate	$70,865.15
Max. Negotiated Rate	$232,736.09
Rate for Payer: Aetna Medicare Advantage	$232,736.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$185,855.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$185,855.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$74,594.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$185,855.39
Rate for Payer: Cigna Commercial	$124,021.42
Rate for Payer: Cigna Medicare Advantage	$74,594.90
Rate for Payer: Clover Medicare Advantage	$70,865.15
Rate for Payer: EmblemHealth Commercial	$223,784.70
Rate for Payer: Humana Medicare Advantage	$76,832.75
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$74,594.90
Rate for Payer: Oxford Commercial	$89,135.84
Rate for Payer: UnitedHealthcare Commercial	$156,302.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$74,594.90
Rate for Payer: Wellcare Medicare Advantage	$74,594.90

SIMVASTATIN 10 MG TAB

Facility

$20.85

Hospital Charge Code	60627622
Hospital Revenue Code	250
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$3.13
Rate for Payer: Qualcare PPO/HMO/WC	$3.13

SIMVASTATIN 10 MG TAB

Facility

$20.85

Hospital Charge Code	60627622
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$10.43
Rate for Payer: Aetna Commercial	$7.92
Rate for Payer: Aetna Medicare Advantage	$6.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.32
Rate for Payer: Cigna Commercial	$10.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.25
Rate for Payer: Oxford Commercial	$4.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.13
Rate for Payer: UnitedHealthcare Commercial	$4.17
Rate for Payer: UnitedHealthcare Community & State	$0.50
Rate for Payer: Wellpoint Medicaid Managed Care	$0.55

SIMVASTATIN 20 MG TAB

Facility

$29.65

Hospital Charge Code	60628704
Hospital Revenue Code	250
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$14.82
Rate for Payer: Aetna Commercial	$11.27
Rate for Payer: Aetna Medicare Advantage	$8.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.56
Rate for Payer: Cigna Commercial	$14.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.89
Rate for Payer: Oxford Commercial	$5.93
Rate for Payer: Qualcare PPO/HMO/WC	$4.45
Rate for Payer: UnitedHealthcare Commercial	$5.93
Rate for Payer: UnitedHealthcare Community & State	$0.71
Rate for Payer: Wellpoint Medicaid Managed Care	$0.79

SIMVASTATIN 20 MG TAB

Facility

$29.65

Hospital Charge Code	60628704
Hospital Revenue Code	250
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$4.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.45

SIMVASTATIN 40 MG TAB

Facility

$2.45

Hospital Charge Code	60628869
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

SIMVASTATIN 40 MG TAB

Facility

$2.45

Hospital Charge Code	60628869
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.93
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.74
Rate for Payer: Oxford Commercial	$0.49
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$0.49
Rate for Payer: UnitedHealthcare Community & State	$0.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.06

SIMVASTATIN 5 MG TAB

Facility

$16.00

Hospital Charge Code	60629047
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.40

SIMVASTATIN 5 MG TAB

Facility

$16.00

Hospital Charge Code	60629047
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$6.08
Rate for Payer: Aetna Medicare Advantage	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.08
Rate for Payer: Cigna Commercial	$8.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.80
Rate for Payer: Oxford Commercial	$3.20
Rate for Payer: Qualcare PPO/HMO/WC	$2.40
Rate for Payer: UnitedHealthcare Commercial	$3.20
Rate for Payer: UnitedHealthcare Community & State	$0.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.42

SINCALIDE 5 MCG INJ

Facility

$411.80

Hospital Charge Code	60627873
Hospital Revenue Code	250
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$205.90
Rate for Payer: Aetna Commercial	$156.48
Rate for Payer: Aetna Medicare Advantage	$123.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.01
Rate for Payer: Cigna Commercial	$205.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.54
Rate for Payer: Oxford Commercial	$82.36
Rate for Payer: Qualcare PPO/HMO/WC	$61.77
Rate for Payer: UnitedHealthcare Commercial	$82.36
Rate for Payer: UnitedHealthcare Community & State	$9.92
Rate for Payer: Wellpoint Medicaid Managed Care	$10.91

SINCALIDE 5 MCG INJ

Facility

$411.80

Hospital Charge Code	60627873
Hospital Revenue Code	250
Min. Negotiated Rate	$61.77
Max. Negotiated Rate	$61.77
Rate for Payer: Qualcare PPO/HMO/WC	$61.77

SINCALIDE 5 MCG VIAL

Facility

$579.35

Service Code	HCPCS J2805
Hospital Charge Code	6063943241
Hospital Revenue Code	636
Min. Negotiated Rate	$86.90
Max. Negotiated Rate	$140.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.20
Rate for Payer: Qualcare PPO/HMO/WC	$86.90

SINCALIDE 5 MCG VIAL

Facility

$579.35

Service Code	HCPCS J2805
Hospital Charge Code	6063943241
Hospital Revenue Code	636
Min. Negotiated Rate	$13.96
Max. Negotiated Rate	$289.68
Rate for Payer: Aetna Commercial	$220.15
Rate for Payer: Aetna Medicare Advantage	$173.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.73
Rate for Payer: Cigna Commercial	$289.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.20
Rate for Payer: Qualcare PPO/HMO/WC	$86.90
Rate for Payer: UnitedHealthcare Community & State	$13.96
Rate for Payer: Wellpoint Medicaid Managed Care	$15.35

Know your out-of-pocket cost for care.

All Charges