Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SINU FOAM

Facility

$405.00

Hospital Charge Code	270686807
Hospital Revenue Code	272
Min. Negotiated Rate	$9.76
Max. Negotiated Rate	$202.50
Rate for Payer: Aetna Commercial	$153.90
Rate for Payer: Aetna Medicare Advantage	$121.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.28
Rate for Payer: Cigna Commercial	$202.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.50
Rate for Payer: Oxford Commercial	$81.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.75
Rate for Payer: UnitedHealthcare Commercial	$81.00
Rate for Payer: UnitedHealthcare Community & State	$9.76
Rate for Payer: Wellpoint Medicaid Managed Care	$10.73

SINUS AND MASTOID PROCEDURES WITH CC/MCC

Facility

$72,272.09

Service Code	MSDRG 135
Min. Negotiated Rate	$22,005.92
Max. Negotiated Rate	$72,272.09
Rate for Payer: Aetna Commercial	$49,916.49
Rate for Payer: Aetna Medicare Advantage	$72,272.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61,641.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61,641.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23,164.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61,641.65
Rate for Payer: Cigna Commercial	$39,583.85
Rate for Payer: Cigna Medicare Advantage	$23,164.13
Rate for Payer: Clover Medicare Advantage	$22,005.92
Rate for Payer: EmblemHealth Commercial	$69,492.39
Rate for Payer: Humana Medicare Advantage	$23,859.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$23,164.13
Rate for Payer: Oxford Commercial	$28,449.44
Rate for Payer: UnitedHealthcare Commercial	$49,886.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$23,164.13
Rate for Payer: Wellcare Medicare Advantage	$23,164.13

SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC

Facility

$34,950.21

Service Code	MSDRG 136
Min. Negotiated Rate	$10,641.89
Max. Negotiated Rate	$34,950.21
Rate for Payer: Aetna Commercial	$24,272.09
Rate for Payer: Aetna Medicare Advantage	$34,950.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,191.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,191.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11,201.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24,191.44
Rate for Payer: Cigna Commercial	$19,000.32
Rate for Payer: Cigna Medicare Advantage	$11,201.99
Rate for Payer: Clover Medicare Advantage	$10,641.89
Rate for Payer: EmblemHealth Commercial	$33,605.97
Rate for Payer: Humana Medicare Advantage	$11,538.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11,201.99
Rate for Payer: Oxford Commercial	$13,655.78
Rate for Payer: UnitedHealthcare Commercial	$23,945.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$11,201.99
Rate for Payer: Wellcare Medicare Advantage	$11,201.99

SINUS GUIDE CATH GC000/GC070

Facility

$512.00

Hospital Charge Code	270335942
Hospital Revenue Code	278
Min. Negotiated Rate	$76.80
Max. Negotiated Rate	$123.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$102.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$112.64
Rate for Payer: Qualcare PPO/HMO/WC	$76.80

SINUS GUIDE CATH GC000/GC070

Facility

$512.00

Hospital Charge Code	270335942
Hospital Revenue Code	278
Min. Negotiated Rate	$12.34
Max. Negotiated Rate	$256.00
Rate for Payer: Aetna Commercial	$194.56
Rate for Payer: Aetna Medicare Advantage	$153.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$102.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$130.56
Rate for Payer: Cigna Commercial	$256.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$112.64
Rate for Payer: Qualcare PPO/HMO/WC	$76.80
Rate for Payer: UnitedHealthcare Community & State	$12.34
Rate for Payer: Wellpoint Medicaid Managed Care	$13.57

SINUS GUIDEWIRE TW35080V

Facility

$385.00

Hospital Charge Code	270335943
Hospital Revenue Code	278
Min. Negotiated Rate	$9.28
Max. Negotiated Rate	$192.50
Rate for Payer: Aetna Commercial	$146.30
Rate for Payer: Aetna Medicare Advantage	$115.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.17
Rate for Payer: Cigna Commercial	$192.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$57.75
Rate for Payer: UnitedHealthcare Community & State	$9.28
Rate for Payer: Wellpoint Medicaid Managed Care	$10.20

SINUS GUIDEWIRE TW35080V

Facility

$385.00

Hospital Charge Code	270335943
Hospital Revenue Code	278
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$93.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$57.75

SINUTAB/TAB

Facility

$3.00

Hospital Charge Code	60633889
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

SINUTAB/TAB

Facility

$3.00

Hospital Charge Code	60633889
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SIROLIM

Facility

$181.65

Service Code	HCPCS 80299
Hospital Charge Code	3001314
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

SIROLIM

Facility

$181.65

Service Code	HCPCS 80299
Hospital Charge Code	3001314
Hospital Revenue Code	301
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$90.83
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$4.81

SIROLIMUS

Facility

$390.00

Service Code	HCPCS 80195
Hospital Charge Code	38477217
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SIROLIMUS

Facility

$94.35

Service Code	HCPCS 80195
Hospital Charge Code	39900010
Hospital Revenue Code	301
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$37.35
Rate for Payer: Aetna Medicare Advantage	$44.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.56
Rate for Payer: Cigna Commercial	$47.17
Rate for Payer: Cigna Medicare Advantage	$13.73
Rate for Payer: Clover Medicare Advantage	$13.04
Rate for Payer: EmblemHealth Commercial	$41.19
Rate for Payer: Humana Medicare Advantage	$14.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.73
Rate for Payer: Wellcare Medicare Advantage	$13.73
Rate for Payer: Wellpoint Medicaid Managed Care	$2.50

SIROLIMUS

Facility

$94.35

Service Code	HCPCS 80195
Hospital Charge Code	39900010
Hospital Revenue Code	301
Min. Negotiated Rate	$14.15
Max. Negotiated Rate	$14.15
Rate for Payer: Qualcare PPO/HMO/WC	$14.15

SIROLIMUS

Facility

$390.00

Service Code	HCPCS 80195
Hospital Charge Code	38477217
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$37.35
Rate for Payer: Aetna Medicare Advantage	$44.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.56
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$13.73
Rate for Payer: Clover Medicare Advantage	$13.04
Rate for Payer: EmblemHealth Commercial	$41.19
Rate for Payer: Humana Medicare Advantage	$14.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.73
Rate for Payer: Wellcare Medicare Advantage	$13.73
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

SI SCREW FULLY THREADED 12X50M

Facility

$15,625.00

Hospital Charge Code	270702056
Hospital Revenue Code	270
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) PPO	$3,984.38
Rate for Payer: Cigna Commercial	$7,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,687.50
Rate for Payer: Oxford Commercial	$3,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,343.75
Rate for Payer: UnitedHealthcare Commercial	$3,125.00
Rate for Payer: UnitedHealthcare Community & State	$376.56
Rate for Payer: Wellpoint Medicaid Managed Care	$414.06

SI SCREW FULLY THREADED 12X50M

Facility

$15,625.00

Hospital Charge Code	270702056
Hospital Revenue Code	270
Min. Negotiated Rate	$2,343.75
Max. Negotiated Rate	$2,343.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,343.75

SI SCREW FULLY THREADED 12X70M

Facility

$15,625.00

Hospital Charge Code	270702057
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

SI SCREW FULLY THREADED 12X70M

Facility

$15,625.00

Hospital Charge Code	270702057
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

S&I STENT/CHEST VERT ART

Facility

$37,614.35

Service Code	HCPCS 0076T
Hospital Charge Code	41100076T
Hospital Revenue Code	361
Min. Negotiated Rate	$906.51
Max. Negotiated Rate	$18,807.17
Rate for Payer: Aetna Commercial	$14,293.45
Rate for Payer: Aetna Medicare Advantage	$11,284.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,591.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,591.66
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	$9,591.66
Rate for Payer: Cigna Commercial	$18,807.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,284.31
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$906.51
Rate for Payer: Wellpoint Medicaid Managed Care	$996.78

S&I STENT/CHEST VERT ART

Facility

$37,614.35

Service Code	HCPCS 0076T
Hospital Charge Code	41100076T
Hospital Revenue Code	361
Min. Negotiated Rate	$5,642.15
Max. Negotiated Rate	$5,642.15
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15

S&I STENT/CHEST VERT ART

Facility

$37,614.35

Service Code	HCPCS 0076T
Hospital Charge Code	36680076T
Hospital Revenue Code	361
Min. Negotiated Rate	$5,642.15
Max. Negotiated Rate	$5,642.15
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15

S&I STENT/CHEST VERT ART

Facility

$37,614.35

Service Code	HCPCS 0076T
Hospital Charge Code	36680076T
Hospital Revenue Code	361
Min. Negotiated Rate	$906.51
Max. Negotiated Rate	$18,807.17
Rate for Payer: Aetna Commercial	$14,293.45
Rate for Payer: Aetna Medicare Advantage	$11,284.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,591.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,591.66
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	$9,591.66
Rate for Payer: Cigna Commercial	$18,807.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,284.31
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$906.51
Rate for Payer: Wellpoint Medicaid Managed Care	$996.78

SITAGLIPTIN PHOSPHATE 100MG TB

Facility

$88.57

Service Code	NDC 6027728
Hospital Charge Code	60630092
Hospital Revenue Code	250
Min. Negotiated Rate	$13.29
Max. Negotiated Rate	$13.29
Rate for Payer: Qualcare PPO/HMO/WC	$13.29

SITAGLIPTIN PHOSPHATE 100MG TB

Facility

$88.57

Service Code	NDC 6027728
Hospital Charge Code	60630092
Hospital Revenue Code	250
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$44.28
Rate for Payer: Aetna Commercial	$33.66
Rate for Payer: Aetna Medicare Advantage	$26.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.59
Rate for Payer: Cigna Commercial	$44.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.57
Rate for Payer: Oxford Commercial	$17.71
Rate for Payer: Qualcare PPO/HMO/WC	$13.29
Rate for Payer: UnitedHealthcare Commercial	$17.71
Rate for Payer: UnitedHealthcare Community & State	$2.13
Rate for Payer: Wellpoint Medicaid Managed Care	$2.35

Know your out-of-pocket cost for care.

All Charges