Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SODIUM PHOS INJ 15ML

Facility

$9.58

Service Code	NDC 409739172
Hospital Charge Code	60627936
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.79
Rate for Payer: Aetna Commercial	$3.64
Rate for Payer: Aetna Medicare Advantage	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.44
Rate for Payer: Cigna Commercial	$4.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.87
Rate for Payer: Oxford Commercial	$1.92
Rate for Payer: Qualcare PPO/HMO/WC	$1.44
Rate for Payer: UnitedHealthcare Commercial	$1.92
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

SODIUM PHOSPHATE INJ/3MM

Facility

$5.00

Hospital Charge Code	60634800
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

SODIUM PHOSPHATE INJ/3MM

Facility

$5.00

Hospital Charge Code	60634800
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

SODIUM PLSTY SLF/SUP 1.25G 5ML

Facility

$64.00

Hospital Charge Code	6004931
Hospital Revenue Code	251
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$24.32
Rate for Payer: Aetna Medicare Advantage	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.32
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.20
Rate for Payer: Oxford Commercial	$12.80
Rate for Payer: Qualcare PPO/HMO/WC	$9.60
Rate for Payer: UnitedHealthcare Commercial	$12.80
Rate for Payer: UnitedHealthcare Community & State	$1.54
Rate for Payer: Wellpoint Medicaid Managed Care	$1.70

SODIUM PLSTY SLF/SUP 1.25G 5ML

Facility

$64.00

Hospital Charge Code	6004931
Hospital Revenue Code	251
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

SODIUM PLSTY SULF SSP15GM/60ML

Facility

$207.70

Service Code	NDC 46287000660
Hospital Charge Code	60627940
Hospital Revenue Code	250
Min. Negotiated Rate	$5.01
Max. Negotiated Rate	$103.85
Rate for Payer: Aetna Commercial	$78.93
Rate for Payer: Aetna Medicare Advantage	$62.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.96
Rate for Payer: Cigna Commercial	$103.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.31
Rate for Payer: Oxford Commercial	$41.54
Rate for Payer: Qualcare PPO/HMO/WC	$31.16
Rate for Payer: UnitedHealthcare Commercial	$41.54
Rate for Payer: UnitedHealthcare Community & State	$5.01
Rate for Payer: Wellpoint Medicaid Managed Care	$5.50

SODIUM PLSTY SULF SSP15GM/60ML

Facility

$207.70

Service Code	NDC 46287000660
Hospital Charge Code	60627940
Hospital Revenue Code	250
Min. Negotiated Rate	$31.16
Max. Negotiated Rate	$31.16
Rate for Payer: Qualcare PPO/HMO/WC	$31.16

SODIUM POLYSTYRENE SULFON

Facility

$48.00

Hospital Charge Code	60633909
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$18.24
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.40
Rate for Payer: Oxford Commercial	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$9.60
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

SODIUM POLYSTYRENE SULFON

Facility

$48.00

Hospital Charge Code	60633909
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

SODIUM, RANDOM URINE

Facility

$390.00

Service Code	HCPCS 84300
Hospital Charge Code	3002481
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SODIUM, RANDOM URINE

Facility

$390.00

Service Code	HCPCS 84300
Hospital Charge Code	3002481
Hospital Revenue Code	301
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$13.76
Rate for Payer: Aetna Medicare Advantage	$16.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.27
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.06
Rate for Payer: Clover Medicare Advantage	$4.81
Rate for Payer: EmblemHealth Commercial	$15.18
Rate for Payer: Humana Medicare Advantage	$5.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.06
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	$4.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.06
Rate for Payer: Wellcare Medicare Advantage	$5.06
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

SODIUM, SERUM

Facility

$94.00

Service Code	HCPCS 84295
Hospital Charge Code	38472608
Hospital Revenue Code	301
Min. Negotiated Rate	$14.10
Max. Negotiated Rate	$14.10
Rate for Payer: Qualcare PPO/HMO/WC	$14.10

SODIUM, SERUM

Facility

$94.00

Service Code	HCPCS 84295
Hospital Charge Code	38472608
Hospital Revenue Code	301
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$13.08
Rate for Payer: Aetna Medicare Advantage	$15.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.36
Rate for Payer: Cigna Commercial	$47.00
Rate for Payer: Cigna Medicare Advantage	$4.81
Rate for Payer: Clover Medicare Advantage	$4.57
Rate for Payer: EmblemHealth Commercial	$14.43
Rate for Payer: Humana Medicare Advantage	$4.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.10
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.81
Rate for Payer: Wellcare Medicare Advantage	$4.81
Rate for Payer: Wellpoint Medicaid Managed Care	$2.49

SODIUM, SERUM (NA)

Facility

$390.00

Service Code	HCPCS 84295
Hospital Charge Code	3002474
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SODIUM, SERUM (NA)

Facility

$390.00

Service Code	HCPCS 84295
Hospital Charge Code	3002474
Hospital Revenue Code	301
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$13.08
Rate for Payer: Aetna Medicare Advantage	$15.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.36
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$4.81
Rate for Payer: Clover Medicare Advantage	$4.57
Rate for Payer: EmblemHealth Commercial	$14.43
Rate for Payer: Humana Medicare Advantage	$4.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.81
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	$3.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.81
Rate for Payer: Wellcare Medicare Advantage	$4.81
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

SODIUM,SERUM NA PANEL

Facility

$16.00

Service Code	HCPCS 84295
Hospital Charge Code	3002474P
Hospital Revenue Code	301
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.40

SODIUM,SERUM NA PANEL

Facility

$16.00

Service Code	HCPCS 84295
Hospital Charge Code	3002474P
Hospital Revenue Code	301
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$13.08
Rate for Payer: Aetna Medicare Advantage	$15.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.36
Rate for Payer: Cigna Commercial	$8.00
Rate for Payer: Cigna Medicare Advantage	$4.81
Rate for Payer: Clover Medicare Advantage	$4.57
Rate for Payer: EmblemHealth Commercial	$14.43
Rate for Payer: Humana Medicare Advantage	$4.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.81
Rate for Payer: Wellcare Medicare Advantage	$4.81
Rate for Payer: Wellpoint Medicaid Managed Care	$0.42

SODIUM TETRAD INJ 1%

Facility

$74.90

Hospital Charge Code	60627664
Hospital Revenue Code	250
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$11.23
Rate for Payer: Qualcare PPO/HMO/WC	$11.23

SODIUM TETRAD INJ 1%

Facility

$74.90

Hospital Charge Code	60627664
Hospital Revenue Code	250
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$37.45
Rate for Payer: Aetna Commercial	$28.46
Rate for Payer: Aetna Medicare Advantage	$22.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.10
Rate for Payer: Cigna Commercial	$37.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.47
Rate for Payer: Oxford Commercial	$14.98
Rate for Payer: Qualcare PPO/HMO/WC	$11.23
Rate for Payer: UnitedHealthcare Commercial	$14.98
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.98

SODIUM TETRAD INJ 3%

Facility

$128.75

Hospital Charge Code	60627665
Hospital Revenue Code	250
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$64.38
Rate for Payer: Aetna Commercial	$48.92
Rate for Payer: Aetna Medicare Advantage	$38.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.83
Rate for Payer: Cigna Commercial	$64.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.62
Rate for Payer: Oxford Commercial	$25.75
Rate for Payer: Qualcare PPO/HMO/WC	$19.31
Rate for Payer: UnitedHealthcare Commercial	$25.75
Rate for Payer: UnitedHealthcare Community & State	$3.10
Rate for Payer: Wellpoint Medicaid Managed Care	$3.41

SODIUM TETRAD INJ 3%

Facility

$128.75

Hospital Charge Code	60627665
Hospital Revenue Code	250
Min. Negotiated Rate	$19.31
Max. Negotiated Rate	$19.31
Rate for Payer: Qualcare PPO/HMO/WC	$19.31

SODIUM TETRAD SULF INJ 1% 2ML

Facility

$48.00

Hospital Charge Code	6005029
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

SODIUM TETRAD SULF INJ 1% 2ML

Facility

$48.00

Hospital Charge Code	6005029
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$18.24
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.40
Rate for Payer: Oxford Commercial	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$9.60
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

SODIUM TETRAD SULF INJ 3% 2ML

Facility

$109.45

Hospital Charge Code	6005037
Hospital Revenue Code	250
Min. Negotiated Rate	$16.42
Max. Negotiated Rate	$16.42
Rate for Payer: Qualcare PPO/HMO/WC	$16.42

SODIUM TETRAD SULF INJ 3% 2ML

Facility

$109.45

Hospital Charge Code	6005037
Hospital Revenue Code	250
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$54.73
Rate for Payer: Aetna Commercial	$41.59
Rate for Payer: Aetna Medicare Advantage	$32.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.91
Rate for Payer: Cigna Commercial	$54.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.84
Rate for Payer: Oxford Commercial	$21.89
Rate for Payer: Qualcare PPO/HMO/WC	$16.42
Rate for Payer: UnitedHealthcare Commercial	$21.89
Rate for Payer: UnitedHealthcare Community & State	$2.64
Rate for Payer: Wellpoint Medicaid Managed Care	$2.90

Know your out-of-pocket cost for care.

All Charges