Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

Sitagliptin Phosphate 25 MG TA

Facility

$88.57

Service Code	NDC 6022128
Hospital Charge Code	60630090
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

Sitagliptin Phosphate 25 MG TA

Facility

$88.57

Service Code	NDC 6022128
Hospital Charge Code	60630090
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 50MG TAB

Facility

$88.57

Service Code	NDC 6011228
Hospital Charge Code	60630091
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 50MG TAB

Facility

$88.57

Service Code	NDC 6011228
Hospital Charge Code	60630091
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

SITE SOLUTION ADMIN SET

Facility

$36.00

Hospital Charge Code	270331116
Hospital Revenue Code	272
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$5.40

SITE SOLUTION ADMIN SET

Facility

$36.00

Hospital Charge Code	270331116
Hospital Revenue Code	272
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna Commercial	$13.68
Rate for Payer: Aetna Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.18
Rate for Payer: Cigna Commercial	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.80
Rate for Payer: Oxford Commercial	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$5.40
Rate for Payer: UnitedHealthcare Commercial	$7.20
Rate for Payer: UnitedHealthcare Community & State	$0.87
Rate for Payer: Wellpoint Medicaid Managed Care	$0.95

SITZ BATH

Facility

$10.74

Hospital Charge Code	270649928
Hospital Revenue Code	272
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$1.61
Rate for Payer: Qualcare PPO/HMO/WC	$1.61

SITZ BATH

Facility

$10.74

Hospital Charge Code	270649928
Hospital Revenue Code	272
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.37
Rate for Payer: Aetna Commercial	$4.08
Rate for Payer: Aetna Medicare Advantage	$3.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.74
Rate for Payer: Cigna Commercial	$5.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.22
Rate for Payer: Oxford Commercial	$2.15
Rate for Payer: Qualcare PPO/HMO/WC	$1.61
Rate for Payer: UnitedHealthcare Commercial	$2.15
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

SITZ-BATH **************

Facility

$10.00

Hospital Charge Code	8001596
Hospital Revenue Code	279
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.50

SITZ-BATH **************

Facility

$10.00

Hospital Charge Code	8001596
Hospital Revenue Code	279
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$5.00
Rate for Payer: Aetna Commercial	$3.80
Rate for Payer: Aetna Medicare Advantage	$3.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.55
Rate for Payer: Cigna Commercial	$5.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.00
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.50
Rate for Payer: UnitedHealthcare Commercial	$2.00
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

SITZ BATH PLASTIC

Facility

$5.32

Hospital Charge Code	270301980
Hospital Revenue Code	270
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.80

SITZ BATH PLASTIC

Facility

$5.32

Hospital Charge Code	270301980
Hospital Revenue Code	270
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.66
Rate for Payer: Aetna Commercial	$2.02
Rate for Payer: Aetna Medicare Advantage	$1.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.36
Rate for Payer: Cigna Commercial	$2.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.60
Rate for Payer: Oxford Commercial	$1.06
Rate for Payer: Qualcare PPO/HMO/WC	$0.80
Rate for Payer: UnitedHealthcare Commercial	$1.06
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

SIXING SET FLEX HINGE TOE

Facility

$491.88

Hospital Charge Code	270623471
Hospital Revenue Code	272
Min. Negotiated Rate	$11.85
Max. Negotiated Rate	$245.94
Rate for Payer: Aetna Commercial	$186.91
Rate for Payer: Aetna Medicare Advantage	$147.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$125.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$125.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$125.43
Rate for Payer: Cigna Commercial	$245.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.56
Rate for Payer: Oxford Commercial	$98.38
Rate for Payer: Qualcare PPO/HMO/WC	$73.78
Rate for Payer: UnitedHealthcare Commercial	$98.38
Rate for Payer: UnitedHealthcare Community & State	$11.85
Rate for Payer: Wellpoint Medicaid Managed Care	$13.03

SIXING SET FLEX HINGE TOE

Facility

$491.88

Hospital Charge Code	270623471
Hospital Revenue Code	272
Min. Negotiated Rate	$73.78
Max. Negotiated Rate	$73.78
Rate for Payer: Qualcare PPO/HMO/WC	$73.78

SIZE 12 FMT STD

Facility

$15,948.55

Hospital Charge Code	270657087
Hospital Revenue Code	278
Min. Negotiated Rate	$384.36
Max. Negotiated Rate	$7,974.27
Rate for Payer: Aetna Commercial	$6,060.45
Rate for Payer: Aetna Medicare Advantage	$4,784.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,066.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,066.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,189.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,066.88
Rate for Payer: Cigna Commercial	$7,974.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,859.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,508.68
Rate for Payer: Qualcare PPO/HMO/WC	$2,392.28
Rate for Payer: UnitedHealthcare Community & State	$384.36
Rate for Payer: Wellpoint Medicaid Managed Care	$422.64

SIZE 12 FMT STD

Facility

$15,948.55

Hospital Charge Code	270657087
Hospital Revenue Code	278
Min. Negotiated Rate	$2,392.28
Max. Negotiated Rate	$3,859.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,189.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,859.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,508.68
Rate for Payer: Qualcare PPO/HMO/WC	$2,392.28

SIZE 12 TM STEM

Facility

$21,427.75

Hospital Charge Code	270657088
Hospital Revenue Code	278
Min. Negotiated Rate	$516.41
Max. Negotiated Rate	$10,713.88
Rate for Payer: Aetna Commercial	$8,142.55
Rate for Payer: Aetna Medicare Advantage	$6,428.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,464.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,464.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,285.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,464.08
Rate for Payer: Cigna Commercial	$10,713.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,185.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,714.10
Rate for Payer: Qualcare PPO/HMO/WC	$3,214.16
Rate for Payer: UnitedHealthcare Community & State	$516.41
Rate for Payer: Wellpoint Medicaid Managed Care	$567.84

SIZE 12 TM STEM

Facility

$21,427.75

Hospital Charge Code	270657088
Hospital Revenue Code	278
Min. Negotiated Rate	$3,214.16
Max. Negotiated Rate	$5,185.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,285.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,185.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,714.10
Rate for Payer: Qualcare PPO/HMO/WC	$3,214.16

SIZE 13 210MM CRC

Facility

$27,168.70

Hospital Charge Code	270657089
Hospital Revenue Code	278
Min. Negotiated Rate	$4,075.30
Max. Negotiated Rate	$6,574.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,433.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,574.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,977.11
Rate for Payer: Qualcare PPO/HMO/WC	$4,075.30

SIZE 13 210MM CRC

Facility

$27,168.70

Hospital Charge Code	270657089
Hospital Revenue Code	278
Min. Negotiated Rate	$654.77
Max. Negotiated Rate	$13,584.35
Rate for Payer: Aetna Commercial	$10,324.11
Rate for Payer: Aetna Medicare Advantage	$8,150.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,928.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,928.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,433.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,928.02
Rate for Payer: Cigna Commercial	$13,584.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,574.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,977.11
Rate for Payer: Qualcare PPO/HMO/WC	$4,075.30
Rate for Payer: UnitedHealthcare Community & State	$654.77
Rate for Payer: Wellpoint Medicaid Managed Care	$719.97

SIZE 13 LM FMT

Facility

$15,948.55

Hospital Charge Code	270657090
Hospital Revenue Code	278
Min. Negotiated Rate	$384.36
Max. Negotiated Rate	$7,974.27
Rate for Payer: Aetna Commercial	$6,060.45
Rate for Payer: Aetna Medicare Advantage	$4,784.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,066.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,066.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,189.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,066.88
Rate for Payer: Cigna Commercial	$7,974.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,859.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,508.68
Rate for Payer: Qualcare PPO/HMO/WC	$2,392.28
Rate for Payer: UnitedHealthcare Community & State	$384.36
Rate for Payer: Wellpoint Medicaid Managed Care	$422.64

SIZE 13 LM FMT

Facility

$15,948.55

Hospital Charge Code	270657090
Hospital Revenue Code	278
Min. Negotiated Rate	$2,392.28
Max. Negotiated Rate	$3,859.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,189.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,859.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,508.68
Rate for Payer: Qualcare PPO/HMO/WC	$2,392.28

SIZE 14 LM FMT

Facility

$15,948.55

Hospital Charge Code	270657091
Hospital Revenue Code	278
Min. Negotiated Rate	$2,392.28
Max. Negotiated Rate	$3,859.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,189.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,859.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,508.68
Rate for Payer: Qualcare PPO/HMO/WC	$2,392.28

SIZE 14 LM FMT

Facility

$15,948.55

Hospital Charge Code	270657091
Hospital Revenue Code	278
Min. Negotiated Rate	$384.36
Max. Negotiated Rate	$7,974.27
Rate for Payer: Aetna Commercial	$6,060.45
Rate for Payer: Aetna Medicare Advantage	$4,784.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,066.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,066.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,189.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,066.88
Rate for Payer: Cigna Commercial	$7,974.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,859.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,508.68
Rate for Payer: Qualcare PPO/HMO/WC	$2,392.28
Rate for Payer: UnitedHealthcare Community & State	$384.36
Rate for Payer: Wellpoint Medicaid Managed Care	$422.64

SIZE 15 LIM FMT

Facility

$15,948.55

Hospital Charge Code	270657093
Hospital Revenue Code	278
Min. Negotiated Rate	$384.36
Max. Negotiated Rate	$7,974.27
Rate for Payer: Aetna Commercial	$6,060.45
Rate for Payer: Aetna Medicare Advantage	$4,784.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,066.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,066.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,189.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,066.88
Rate for Payer: Cigna Commercial	$7,974.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,859.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,508.68
Rate for Payer: Qualcare PPO/HMO/WC	$2,392.28
Rate for Payer: UnitedHealthcare Community & State	$384.36
Rate for Payer: Wellpoint Medicaid Managed Care	$422.64

Know your out-of-pocket cost for care.

All Charges