Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SINEQUAN/150MG/CAP

Facility

$8.00

Hospital Charge Code	60633888
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

SINEQUAN/50MG/CAP

Facility

$4.00

Hospital Charge Code	60633887
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SINEQUAN/50MG/CAP

Facility

$4.00

Hospital Charge Code	60633887
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

SINGLE HALE NOT PUSHER

Facility

$2,250.00

Hospital Charge Code	270656570
Hospital Revenue Code	272
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

SINGLE HALE NOT PUSHER

Facility

$2,250.00

Hospital Charge Code	270656570
Hospital Revenue Code	272
Min. Negotiated Rate	$54.23
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$675.00
Rate for Payer: Oxford Commercial	$450.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$450.00
Rate for Payer: UnitedHealthcare Community & State	$54.23
Rate for Payer: Wellpoint Medicaid Managed Care	$59.62

SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL

Facility

$132,083.27

Service Code	MSDRG 402
Min. Negotiated Rate	$40,217.66
Max. Negotiated Rate	$132,083.27
Rate for Payer: Aetna Commercial	$91,013.58
Rate for Payer: Aetna Medicare Advantage	$132,083.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$42,334.38
Rate for Payer: Cigna Commercial	$75,239.64
Rate for Payer: Cigna Medicare Advantage	$42,334.38
Rate for Payer: Clover Medicare Advantage	$40,217.66
Rate for Payer: EmblemHealth Commercial	$127,003.14
Rate for Payer: Humana Medicare Advantage	$43,604.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$42,334.38
Rate for Payer: Oxford Commercial	$54,075.72
Rate for Payer: UnitedHealthcare Commercial	$94,823.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$42,334.38
Rate for Payer: Wellcare Medicare Advantage	$42,334.38

SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE

Facility

$174,395.52

Service Code	MSDRG 450
Min. Negotiated Rate	$53,101.20
Max. Negotiated Rate	$174,395.52
Rate for Payer: Aetna Commercial	$120,086.95
Rate for Payer: Aetna Medicare Advantage	$174,395.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$55,896.00
Rate for Payer: Cigna Commercial	$99,738.13
Rate for Payer: Cigna Medicare Advantage	$55,896.00
Rate for Payer: Clover Medicare Advantage	$53,101.20
Rate for Payer: EmblemHealth Commercial	$167,688.00
Rate for Payer: Humana Medicare Advantage	$57,572.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$55,896.00
Rate for Payer: Oxford Commercial	$71,683.12
Rate for Payer: UnitedHealthcare Commercial	$125,698.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$55,896.00
Rate for Payer: Wellcare Medicare Advantage	$55,896.00

SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC

Facility

$106,545.94

Service Code	MSDRG 451
Min. Negotiated Rate	$32,441.87
Max. Negotiated Rate	$106,545.94
Rate for Payer: Aetna Commercial	$73,466.52
Rate for Payer: Aetna Medicare Advantage	$106,545.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34,149.34
Rate for Payer: Cigna Commercial	$60,453.71
Rate for Payer: Cigna Medicare Advantage	$34,149.34
Rate for Payer: Clover Medicare Advantage	$32,441.87
Rate for Payer: EmblemHealth Commercial	$102,448.02
Rate for Payer: Humana Medicare Advantage	$35,173.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34,149.34
Rate for Payer: Oxford Commercial	$43,448.88
Rate for Payer: UnitedHealthcare Commercial	$76,188.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$34,149.34
Rate for Payer: Wellcare Medicare Advantage	$34,149.34

SINGLE USE ADULT BP CUFF

Facility

$29.20

Hospital Charge Code	270654010
Hospital Revenue Code	272
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$14.60
Rate for Payer: Aetna Commercial	$11.10
Rate for Payer: Aetna Medicare Advantage	$8.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.45
Rate for Payer: Cigna Commercial	$14.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.76
Rate for Payer: Oxford Commercial	$5.84
Rate for Payer: Qualcare PPO/HMO/WC	$4.38
Rate for Payer: UnitedHealthcare Commercial	$5.84
Rate for Payer: UnitedHealthcare Community & State	$0.70
Rate for Payer: Wellpoint Medicaid Managed Care	$0.77

SINGLE USE ADULT BP CUFF

Facility

$29.20

Hospital Charge Code	270654010
Hospital Revenue Code	272
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$4.38
Rate for Payer: Qualcare PPO/HMO/WC	$4.38

SINGLE USE HUMIDIFYING CHAMBER

Facility

$98.00

Hospital Charge Code	270332051
Hospital Revenue Code	272
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$49.00
Rate for Payer: Aetna Commercial	$37.24
Rate for Payer: Aetna Medicare Advantage	$29.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.99
Rate for Payer: Cigna Commercial	$49.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.40
Rate for Payer: Oxford Commercial	$19.60
Rate for Payer: Qualcare PPO/HMO/WC	$14.70
Rate for Payer: UnitedHealthcare Commercial	$19.60
Rate for Payer: UnitedHealthcare Community & State	$2.36
Rate for Payer: Wellpoint Medicaid Managed Care	$2.60

SINGLE USE HUMIDIFYING CHAMBER

Facility

$98.00

Hospital Charge Code	270332051
Hospital Revenue Code	272
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$14.70
Rate for Payer: Qualcare PPO/HMO/WC	$14.70

SINGLE USE LIGATING DEVICE

Facility

$867.00

Hospital Charge Code	270325383
Hospital Revenue Code	272
Min. Negotiated Rate	$130.05
Max. Negotiated Rate	$130.05
Rate for Payer: Qualcare PPO/HMO/WC	$130.05

SINGLE USE LIGATING DEVICE

Facility

$174.00

Hospital Charge Code	270325685
Hospital Revenue Code	272
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$26.10
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

SINGLE USE LIGATING DEVICE

Facility

$174.00

Hospital Charge Code	270325685
Hospital Revenue Code	272
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$87.00
Rate for Payer: Aetna Commercial	$66.12
Rate for Payer: Aetna Medicare Advantage	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.37
Rate for Payer: Cigna Commercial	$87.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.20
Rate for Payer: Oxford Commercial	$34.80
Rate for Payer: Qualcare PPO/HMO/WC	$26.10
Rate for Payer: UnitedHealthcare Commercial	$34.80
Rate for Payer: UnitedHealthcare Community & State	$4.19
Rate for Payer: Wellpoint Medicaid Managed Care	$4.61

SINGLE USE LIGATING DEVICE

Facility

$867.00

Hospital Charge Code	270325383
Hospital Revenue Code	272
Min. Negotiated Rate	$20.89
Max. Negotiated Rate	$433.50
Rate for Payer: Aetna Commercial	$329.46
Rate for Payer: Aetna Medicare Advantage	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$221.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$221.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$221.09
Rate for Payer: Cigna Commercial	$433.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.10
Rate for Payer: Oxford Commercial	$173.40
Rate for Payer: Qualcare PPO/HMO/WC	$130.05
Rate for Payer: UnitedHealthcare Commercial	$173.40
Rate for Payer: UnitedHealthcare Community & State	$20.89
Rate for Payer: Wellpoint Medicaid Managed Care	$22.98

SING/MULT TRIGGER PTS INJ 3 OR

Facility

$1,091.00

Service Code	HCPCS 20553
Hospital Charge Code	5780025
Hospital Revenue Code	450
Min. Negotiated Rate	$28.91
Max. Negotiated Rate	$1,316.35
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,316.35
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$327.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$163.65
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$28.91

SING/MULT TRIGGER PTS INJ 3 OR

Facility

$1,091.00

Service Code	HCPCS 20553
Hospital Charge Code	5780025
Hospital Revenue Code	450
Min. Negotiated Rate	$163.65
Max. Negotiated Rate	$163.65
Rate for Payer: Qualcare PPO/HMO/WC	$163.65

SINGULAIR 4MG CHEWTAB

Facility

$16.00

Hospital Charge Code	60635587
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

SINGULAIR 4MG CHEWTAB

Facility

$16.00

Hospital Charge Code	60635587
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.40

SINGULAIR 5MG CHEW TAB

Facility

$37.92

Service Code	NDC 54028913
Hospital Charge Code	60635505
Hospital Revenue Code	250
Min. Negotiated Rate	$5.69
Max. Negotiated Rate	$5.69
Rate for Payer: Qualcare PPO/HMO/WC	$5.69

SINGULAIR 5MG CHEW TAB

Facility

$37.92

Service Code	NDC 54028913
Hospital Charge Code	60635505
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$18.96
Rate for Payer: Aetna Commercial	$14.41
Rate for Payer: Aetna Medicare Advantage	$11.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.67
Rate for Payer: Cigna Commercial	$18.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.38
Rate for Payer: Oxford Commercial	$7.58
Rate for Payer: Qualcare PPO/HMO/WC	$5.69
Rate for Payer: UnitedHealthcare Commercial	$7.58
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$1.00

SINGULAR 4MG ORAL GRANULE

Facility

$50.05

Service Code	NDC 6384130
Hospital Charge Code	60635657
Hospital Revenue Code	250
Min. Negotiated Rate	$7.51
Max. Negotiated Rate	$7.51
Rate for Payer: Qualcare PPO/HMO/WC	$7.51

SINGULAR 4MG ORAL GRANULE

Facility

$50.05

Service Code	NDC 6384130
Hospital Charge Code	60635657
Hospital Revenue Code	250
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$25.02
Rate for Payer: Aetna Commercial	$19.02
Rate for Payer: Aetna Medicare Advantage	$15.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.76
Rate for Payer: Cigna Commercial	$25.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.02
Rate for Payer: Oxford Commercial	$10.01
Rate for Payer: Qualcare PPO/HMO/WC	$7.51
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Community & State	$1.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.33

SINU FOAM

Facility

$405.00

Hospital Charge Code	270686807
Hospital Revenue Code	272
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$60.75
Rate for Payer: Qualcare PPO/HMO/WC	$60.75

Know your out-of-pocket cost for care.

All Charges