Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SOLUBLE TRANSFERRIN RECEPTOR

Facility

$290.00

Service Code	HCPCS 84238
Hospital Charge Code	38472301
Hospital Revenue Code	301
Min. Negotiated Rate	$43.50
Max. Negotiated Rate	$43.50
Rate for Payer: Qualcare PPO/HMO/WC	$43.50

SOLU-MEDROL/1000MG

Facility

$66.00

Hospital Charge Code	60633911
Hospital Revenue Code	636
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$15.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.97
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

SOLU-MEDROL/1000MG

Facility

$66.00

Hospital Charge Code	60633911
Hospital Revenue Code	636
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$25.08
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.97
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Community & State	$1.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1.75

SOLUMEDROL 1 GRAM VIAL

Facility

$120.00

Hospital Charge Code	60635634
Hospital Revenue Code	636
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$29.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.04
Rate for Payer: Qualcare PPO/HMO/WC	$18.00

SOLUMEDROL 1 GRAM VIAL

Facility

$120.00

Hospital Charge Code	60635634
Hospital Revenue Code	636
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$60.00
Rate for Payer: Aetna Commercial	$45.60
Rate for Payer: Aetna Medicare Advantage	$36.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.60
Rate for Payer: Cigna Commercial	$60.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.04
Rate for Payer: Qualcare PPO/HMO/WC	$18.00
Rate for Payer: UnitedHealthcare Community & State	$2.89
Rate for Payer: Wellpoint Medicaid Managed Care	$3.18

SOLUMEDROL 40MG

Facility

$14.47

Hospital Charge Code	60635755
Hospital Revenue Code	636
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.17

SOLUMEDROL 40MG

Facility

$14.47

Hospital Charge Code	60635755
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$7.24
Rate for Payer: Aetna Commercial	$5.50
Rate for Payer: Aetna Medicare Advantage	$4.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.69
Rate for Payer: Cigna Commercial	$7.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.17
Rate for Payer: UnitedHealthcare Community & State	$0.35
Rate for Payer: Wellpoint Medicaid Managed Care	$0.38

SOLU-MEDROL 40MG VIAL

Facility

$16.00

Hospital Charge Code	83652591
Hospital Revenue Code	636
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$3.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.87
Rate for Payer: Qualcare PPO/HMO/WC	$2.40

SOLU-MEDROL 40MG VIAL

Facility

$16.00

Hospital Charge Code	83652591
Hospital Revenue Code	636
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	$3.87
Rate for Payer: Qualcare PPO/HMO/WC	$2.40
Rate for Payer: UnitedHealthcare Community & State	$0.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.42

SOLUMEDROL 40MG VIAL

Facility

$18.00

Hospital Charge Code	60635248
Hospital Revenue Code	636
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$4.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.36
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

SOLUMEDROL 40MG VIAL

Facility

$18.00

Hospital Charge Code	60635248
Hospital Revenue Code	636
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.36
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

SOLUTION 0.9% NACL IRRG 2B7124

Facility

$19.25

Hospital Charge Code	270303230
Hospital Revenue Code	272
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$2.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.89

SOLUTION 0.9% NACL IRRG 2B7124

Facility

$19.25

Hospital Charge Code	270303230
Hospital Revenue Code	272
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.62
Rate for Payer: Aetna Commercial	$7.32
Rate for Payer: Aetna Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.91
Rate for Payer: Cigna Commercial	$9.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.78
Rate for Payer: Oxford Commercial	$3.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.89
Rate for Payer: UnitedHealthcare Commercial	$3.85
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

SOLUTION 9NACL IRR 1000 2B7231

Facility

$154.50

Hospital Charge Code	270629461
Hospital Revenue Code	272
Min. Negotiated Rate	$23.18
Max. Negotiated Rate	$23.18
Rate for Payer: Qualcare PPO/HMO/WC	$23.18

SOLUTION 9NACL IRR 1000 2B7231

Facility

$154.50

Hospital Charge Code	270629461
Hospital Revenue Code	272
Min. Negotiated Rate	$3.72
Max. Negotiated Rate	$77.25
Rate for Payer: Aetna Commercial	$58.71
Rate for Payer: Aetna Medicare Advantage	$46.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.40
Rate for Payer: Cigna Commercial	$77.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.35
Rate for Payer: Oxford Commercial	$30.90
Rate for Payer: Qualcare PPO/HMO/WC	$23.18
Rate for Payer: UnitedHealthcare Commercial	$30.90
Rate for Payer: UnitedHealthcare Community & State	$3.72
Rate for Payer: Wellpoint Medicaid Managed Care	$4.09

SOLUTION ANTI FOG 6CC

Facility

$6.60

Hospital Charge Code	270641500
Hospital Revenue Code	270
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$0.99
Rate for Payer: Qualcare PPO/HMO/WC	$0.99

SOLUTION ANTI FOG 6CC

Facility

$6.60

Hospital Charge Code	270641500
Hospital Revenue Code	270
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$3.30
Rate for Payer: Aetna Commercial	$2.51
Rate for Payer: Aetna Medicare Advantage	$1.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.68
Rate for Payer: Cigna Commercial	$3.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.98
Rate for Payer: Oxford Commercial	$1.32
Rate for Payer: Qualcare PPO/HMO/WC	$0.99
Rate for Payer: UnitedHealthcare Commercial	$1.32
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

SOLUTION ANTI-FOG FOG OUT

Facility

$528.25

Hospital Charge Code	270656228
Hospital Revenue Code	271
Min. Negotiated Rate	$79.24
Max. Negotiated Rate	$79.24
Rate for Payer: Qualcare PPO/HMO/WC	$79.24

SOLUTION ANTI-FOG FOG OUT

Facility

$528.25

Hospital Charge Code	270656228
Hospital Revenue Code	271
Min. Negotiated Rate	$12.73
Max. Negotiated Rate	$264.12
Rate for Payer: Aetna Commercial	$200.74
Rate for Payer: Aetna Medicare Advantage	$158.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$134.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$134.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$134.70
Rate for Payer: Cigna Commercial	$264.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.47
Rate for Payer: Oxford Commercial	$105.65
Rate for Payer: Qualcare PPO/HMO/WC	$79.24
Rate for Payer: UnitedHealthcare Commercial	$105.65
Rate for Payer: UnitedHealthcare Community & State	$12.73
Rate for Payer: Wellpoint Medicaid Managed Care	$14.00

SOLUTION BSS+

Facility

$241.55

Hospital Charge Code	270600188
Hospital Revenue Code	272
Min. Negotiated Rate	$5.82
Max. Negotiated Rate	$120.78
Rate for Payer: Aetna Commercial	$91.79
Rate for Payer: Aetna Medicare Advantage	$72.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.60
Rate for Payer: Cigna Commercial	$120.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.47
Rate for Payer: Oxford Commercial	$48.31
Rate for Payer: Qualcare PPO/HMO/WC	$36.23
Rate for Payer: UnitedHealthcare Commercial	$48.31
Rate for Payer: UnitedHealthcare Community & State	$5.82
Rate for Payer: Wellpoint Medicaid Managed Care	$6.40

SOLUTION BSS+

Facility

$241.55

Hospital Charge Code	270600188
Hospital Revenue Code	272
Min. Negotiated Rate	$36.23
Max. Negotiated Rate	$36.23
Rate for Payer: Qualcare PPO/HMO/WC	$36.23

SOLUTION BSS 15ml 079515

Facility

$12.45

Hospital Charge Code	270626716
Hospital Revenue Code	272
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$6.22
Rate for Payer: Aetna Commercial	$4.73
Rate for Payer: Aetna Medicare Advantage	$3.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.17
Rate for Payer: Cigna Commercial	$6.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.73
Rate for Payer: Oxford Commercial	$2.49
Rate for Payer: Qualcare PPO/HMO/WC	$1.87
Rate for Payer: UnitedHealthcare Commercial	$2.49
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.33

SOLUTION BSS 15ml 079515

Facility

$12.45

Hospital Charge Code	270626716
Hospital Revenue Code	272
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$1.87
Rate for Payer: Qualcare PPO/HMO/WC	$1.87

SOLUTION BSS 500ML

Facility

$424.00

Hospital Charge Code	270061251
Hospital Revenue Code	272
Min. Negotiated Rate	$10.22
Max. Negotiated Rate	$212.00
Rate for Payer: Aetna Commercial	$161.12
Rate for Payer: Aetna Medicare Advantage	$127.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.12
Rate for Payer: Cigna Commercial	$212.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.20
Rate for Payer: Oxford Commercial	$84.80
Rate for Payer: Qualcare PPO/HMO/WC	$63.60
Rate for Payer: UnitedHealthcare Commercial	$84.80
Rate for Payer: UnitedHealthcare Community & State	$10.22
Rate for Payer: Wellpoint Medicaid Managed Care	$11.24

SOLUTION BSS 500ML

Facility

$424.00

Hospital Charge Code	270061251
Hospital Revenue Code	272
Min. Negotiated Rate	$63.60
Max. Negotiated Rate	$63.60
Rate for Payer: Qualcare PPO/HMO/WC	$63.60

Know your out-of-pocket cost for care.

All Charges