Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SODIUM CL 0.9% INH SOL 3 ML

Facility

$4.00

Service Code	NDC 487930103
Hospital Charge Code	60629119
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SODIUM CL 0.9% INH SOL 3 ML

Facility

$4.00

Service Code	NDC 487930103
Hospital Charge Code	60629119
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

SODIUM,FECES

Facility

$33.45

Service Code	HCPCS 84302
Hospital Charge Code	39900133
Hospital Revenue Code	301
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$13.22
Rate for Payer: Aetna Medicare Advantage	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.54
Rate for Payer: Cigna Commercial	$16.73
Rate for Payer: Cigna Medicare Advantage	$4.86
Rate for Payer: Clover Medicare Advantage	$4.62
Rate for Payer: EmblemHealth Commercial	$14.58
Rate for Payer: Humana Medicare Advantage	$5.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.04
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.02
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.86
Rate for Payer: Wellcare Medicare Advantage	$4.86
Rate for Payer: Wellpoint Medicaid Managed Care	$0.89

SODIUM,FECES

Facility

$33.45

Service Code	HCPCS 84302
Hospital Charge Code	39900133
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$5.02
Rate for Payer: Qualcare PPO/HMO/WC	$5.02

SODIUM HYALURONATE GV INJ

Facility

$765.00

Hospital Charge Code	6011001
Hospital Revenue Code	250
Min. Negotiated Rate	$18.44
Max. Negotiated Rate	$382.50
Rate for Payer: Aetna Commercial	$290.70
Rate for Payer: Aetna Medicare Advantage	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$195.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$195.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$195.07
Rate for Payer: Cigna Commercial	$382.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.50
Rate for Payer: Oxford Commercial	$153.00
Rate for Payer: Qualcare PPO/HMO/WC	$114.75
Rate for Payer: UnitedHealthcare Commercial	$153.00
Rate for Payer: UnitedHealthcare Community & State	$18.44
Rate for Payer: Wellpoint Medicaid Managed Care	$20.27

SODIUM HYALURONATE GV INJ

Facility

$765.00

Hospital Charge Code	6011001
Hospital Revenue Code	250
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$114.75
Rate for Payer: Qualcare PPO/HMO/WC	$114.75

SODIUM HYALURONATE INJ OPH0.55

Facility

$563.00

Hospital Charge Code	6013213
Hospital Revenue Code	250
Min. Negotiated Rate	$13.57
Max. Negotiated Rate	$281.50
Rate for Payer: Aetna Commercial	$213.94
Rate for Payer: Aetna Medicare Advantage	$168.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$143.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$143.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$143.56
Rate for Payer: Cigna Commercial	$281.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.90
Rate for Payer: Oxford Commercial	$112.60
Rate for Payer: Qualcare PPO/HMO/WC	$84.45
Rate for Payer: UnitedHealthcare Commercial	$112.60
Rate for Payer: UnitedHealthcare Community & State	$13.57
Rate for Payer: Wellpoint Medicaid Managed Care	$14.92

SODIUM HYALURONATE INJ OPH0.55

Facility

$563.00

Hospital Charge Code	6013213
Hospital Revenue Code	250
Min. Negotiated Rate	$84.45
Max. Negotiated Rate	$84.45
Rate for Payer: Qualcare PPO/HMO/WC	$84.45

SODIUM HYALURONATE OPH 10MG/ML

Facility

$1,897.50

Hospital Charge Code	60628101
Hospital Revenue Code	250
Min. Negotiated Rate	$45.73
Max. Negotiated Rate	$948.75
Rate for Payer: Aetna Commercial	$721.05
Rate for Payer: Aetna Medicare Advantage	$569.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$483.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$483.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$483.86
Rate for Payer: Cigna Commercial	$948.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$569.25
Rate for Payer: Oxford Commercial	$379.50
Rate for Payer: Qualcare PPO/HMO/WC	$284.62
Rate for Payer: UnitedHealthcare Commercial	$379.50
Rate for Payer: UnitedHealthcare Community & State	$45.73
Rate for Payer: Wellpoint Medicaid Managed Care	$50.28

SODIUM HYALURONATE OPH 10MG/ML

Facility

$1,897.50

Hospital Charge Code	60628101
Hospital Revenue Code	250
Min. Negotiated Rate	$284.62
Max. Negotiated Rate	$284.62
Rate for Payer: Qualcare PPO/HMO/WC	$284.62

SODIUM HYALURONATE OPH 1% .4ML

Facility

$877.00

Hospital Charge Code	6005003
Hospital Revenue Code	250
Min. Negotiated Rate	$21.14
Max. Negotiated Rate	$438.50
Rate for Payer: Aetna Commercial	$333.26
Rate for Payer: Aetna Medicare Advantage	$263.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.63
Rate for Payer: Cigna Commercial	$438.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$263.10
Rate for Payer: Oxford Commercial	$175.40
Rate for Payer: Qualcare PPO/HMO/WC	$131.55
Rate for Payer: UnitedHealthcare Commercial	$175.40
Rate for Payer: UnitedHealthcare Community & State	$21.14
Rate for Payer: Wellpoint Medicaid Managed Care	$23.24

SODIUM HYALURONATE OPH 1% .4ML

Facility

$877.00

Hospital Charge Code	6005003
Hospital Revenue Code	250
Min. Negotiated Rate	$131.55
Max. Negotiated Rate	$131.55
Rate for Payer: Qualcare PPO/HMO/WC	$131.55

SODIUM HYALURONATE OPH1% .75ML

Facility

$1,196.00

Hospital Charge Code	6005011
Hospital Revenue Code	250
Min. Negotiated Rate	$28.82
Max. Negotiated Rate	$598.00
Rate for Payer: Aetna Commercial	$454.48
Rate for Payer: Aetna Medicare Advantage	$358.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$304.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$304.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$304.98
Rate for Payer: Cigna Commercial	$598.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$358.80
Rate for Payer: Oxford Commercial	$239.20
Rate for Payer: Qualcare PPO/HMO/WC	$179.40
Rate for Payer: UnitedHealthcare Commercial	$239.20
Rate for Payer: UnitedHealthcare Community & State	$28.82
Rate for Payer: Wellpoint Medicaid Managed Care	$31.69

SODIUM HYALURONATE OPH1% .75ML

Facility

$1,196.00

Hospital Charge Code	6005011
Hospital Revenue Code	250
Min. Negotiated Rate	$179.40
Max. Negotiated Rate	$179.40
Rate for Payer: Qualcare PPO/HMO/WC	$179.40

SODIUM NITROPRUSSIDE/50MG

Facility

$34.00

Hospital Charge Code	60633908
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.10
Rate for Payer: Qualcare PPO/HMO/WC	$5.10

SODIUM NITROPRUSSIDE/50MG

Facility

$34.00

Hospital Charge Code	60633908
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$17.00
Rate for Payer: Aetna Commercial	$12.92
Rate for Payer: Aetna Medicare Advantage	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.67
Rate for Payer: Cigna Commercial	$17.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.20
Rate for Payer: Oxford Commercial	$6.80
Rate for Payer: Qualcare PPO/HMO/WC	$5.10
Rate for Payer: UnitedHealthcare Commercial	$6.80
Rate for Payer: UnitedHealthcare Community & State	$0.82
Rate for Payer: Wellpoint Medicaid Managed Care	$0.90

SODIUM;OTHER SOURCE

Facility

$34.00

Service Code	HCPCS 84302
Hospital Charge Code	38477039
Hospital Revenue Code	301
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.10
Rate for Payer: Qualcare PPO/HMO/WC	$5.10

SODIUM;OTHER SOURCE

Facility

$34.00

Service Code	HCPCS 84302
Hospital Charge Code	38477039
Hospital Revenue Code	301
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$13.22
Rate for Payer: Aetna Medicare Advantage	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.54
Rate for Payer: Cigna Commercial	$17.00
Rate for Payer: Cigna Medicare Advantage	$4.86
Rate for Payer: Clover Medicare Advantage	$4.62
Rate for Payer: EmblemHealth Commercial	$14.58
Rate for Payer: Humana Medicare Advantage	$5.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.10
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.86
Rate for Payer: Wellcare Medicare Advantage	$4.86
Rate for Payer: Wellpoint Medicaid Managed Care	$0.90

SODIUM PHOS 16.2G/BIPHOS 43.2G

Facility

$10.90

Hospital Charge Code	6010045
Hospital Revenue Code	251
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

SODIUM PHOS 16.2G/BIPHOS 43.2G

Facility

$10.90

Hospital Charge Code	6010045
Hospital Revenue Code	251
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$4.14
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.27
Rate for Payer: Oxford Commercial	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$2.18
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

SODIUM PHOS BIPHOSPHATE 118M

Facility

$4.50

Hospital Charge Code	6013205
Hospital Revenue Code	251
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.71
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.15
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.35
Rate for Payer: Oxford Commercial	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$0.90
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

SODIUM PHOS BIPHOSPHATE 118M

Facility

$4.50

Hospital Charge Code	6013205
Hospital Revenue Code	251
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

SODIUM PHOS BIPHOSPHATE LQ

Facility

$14.05

Hospital Charge Code	60628137
Hospital Revenue Code	250
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$2.11
Rate for Payer: Qualcare PPO/HMO/WC	$2.11

SODIUM PHOS BIPHOSPHATE LQ

Facility

$14.05

Hospital Charge Code	60628137
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$7.03
Rate for Payer: Aetna Commercial	$5.34
Rate for Payer: Aetna Medicare Advantage	$4.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.58
Rate for Payer: Cigna Commercial	$7.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.21
Rate for Payer: Oxford Commercial	$2.81
Rate for Payer: Qualcare PPO/HMO/WC	$2.11
Rate for Payer: UnitedHealthcare Commercial	$2.81
Rate for Payer: UnitedHealthcare Community & State	$0.34
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

SODIUM PHOS INJ 15ML

Facility

$9.58

Service Code	NDC 409739172
Hospital Charge Code	60627936
Hospital Revenue Code	250
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$1.44
Rate for Payer: Qualcare PPO/HMO/WC	$1.44

Know your out-of-pocket cost for care.

All Charges