Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SOLUTION POTASSIUM CHLORIDE

Facility

$83.00

Hospital Charge Code	270331404
Hospital Revenue Code	272
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$41.50
Rate for Payer: Aetna Commercial	$31.54
Rate for Payer: Aetna Medicare Advantage	$24.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.16
Rate for Payer: Cigna Commercial	$41.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.90
Rate for Payer: Oxford Commercial	$16.60
Rate for Payer: Qualcare PPO/HMO/WC	$12.45
Rate for Payer: UnitedHealthcare Commercial	$16.60
Rate for Payer: UnitedHealthcare Community & State	$2.00
Rate for Payer: Wellpoint Medicaid Managed Care	$2.20

SOLUTIONS BETADINE 2OZ

Facility

$3.14

Hospital Charge Code	270650264
Hospital Revenue Code	270
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.47
Rate for Payer: Qualcare PPO/HMO/WC	$0.47

SOLUTIONS BETADINE 2OZ

Facility

$3.14

Hospital Charge Code	270650264
Hospital Revenue Code	270
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.57
Rate for Payer: Aetna Commercial	$1.19
Rate for Payer: Aetna Medicare Advantage	$0.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.80
Rate for Payer: Cigna Commercial	$1.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.94
Rate for Payer: Oxford Commercial	$0.63
Rate for Payer: Qualcare PPO/HMO/WC	$0.47
Rate for Payer: UnitedHealthcare Commercial	$0.63
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

SOLUTION STERILE 2000ML

Facility

$27.66

Hospital Charge Code	270690942
Hospital Revenue Code	270
Min. Negotiated Rate	$4.15
Max. Negotiated Rate	$4.15
Rate for Payer: Qualcare PPO/HMO/WC	$4.15

SOLUTION STERILE 2000ML

Facility

$27.66

Hospital Charge Code	270690942
Hospital Revenue Code	270
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$13.83
Rate for Payer: Aetna Commercial	$10.51
Rate for Payer: Aetna Medicare Advantage	$8.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.05
Rate for Payer: Cigna Commercial	$13.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.30
Rate for Payer: Oxford Commercial	$5.53
Rate for Payer: Qualcare PPO/HMO/WC	$4.15
Rate for Payer: UnitedHealthcare Commercial	$5.53
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.73

SOLUTION STERILE WATER 2000ML

Facility

$39.62

Hospital Charge Code	270690943
Hospital Revenue Code	270
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$19.81
Rate for Payer: Aetna Commercial	$15.06
Rate for Payer: Aetna Medicare Advantage	$11.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.10
Rate for Payer: Cigna Commercial	$19.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.89
Rate for Payer: Oxford Commercial	$7.92
Rate for Payer: Qualcare PPO/HMO/WC	$5.94
Rate for Payer: UnitedHealthcare Commercial	$7.92
Rate for Payer: UnitedHealthcare Community & State	$0.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1.05

SOLUTION STERILE WATER 2000ML

Facility

$39.62

Hospital Charge Code	270690943
Hospital Revenue Code	270
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$5.94
Rate for Payer: Qualcare PPO/HMO/WC	$5.94

SOLUTION WATER STERILE 2000ML

Facility

$28.50

Hospital Charge Code	270690933
Hospital Revenue Code	270
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$14.25
Rate for Payer: Aetna Commercial	$10.83
Rate for Payer: Aetna Medicare Advantage	$8.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.27
Rate for Payer: Cigna Commercial	$14.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.55
Rate for Payer: Oxford Commercial	$5.70
Rate for Payer: Qualcare PPO/HMO/WC	$4.28
Rate for Payer: UnitedHealthcare Commercial	$5.70
Rate for Payer: UnitedHealthcare Community & State	$0.69
Rate for Payer: Wellpoint Medicaid Managed Care	$0.76

SOLUTION WATER STERILE 2000ML

Facility

$28.50

Hospital Charge Code	270690933
Hospital Revenue Code	270
Min. Negotiated Rate	$4.28
Max. Negotiated Rate	$4.28
Rate for Payer: Qualcare PPO/HMO/WC	$4.28

SOL W/4.25%DIANEAL PDII 2000ML

Facility

$174.05

Hospital Charge Code	270650535
Hospital Revenue Code	272
Min. Negotiated Rate	$26.11
Max. Negotiated Rate	$26.11
Rate for Payer: Qualcare PPO/HMO/WC	$26.11

SOL W/4.25%DIANEAL PDII 2000ML

Facility

$174.05

Hospital Charge Code	270650535
Hospital Revenue Code	272
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$87.03
Rate for Payer: Aetna Commercial	$66.14
Rate for Payer: Aetna Medicare Advantage	$52.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.38
Rate for Payer: Cigna Commercial	$87.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.22
Rate for Payer: Oxford Commercial	$34.81
Rate for Payer: Qualcare PPO/HMO/WC	$26.11
Rate for Payer: UnitedHealthcare Commercial	$34.81
Rate for Payer: UnitedHealthcare Community & State	$4.19
Rate for Payer: Wellpoint Medicaid Managed Care	$4.61

SOMA COMPOUND 200-325/TAB

Facility

$8.00

Hospital Charge Code	60633912
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

SOMA COMPOUND 200-325/TAB

Facility

$8.00

Hospital Charge Code	60633912
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

SOMA (PLAIN)

Facility

$6.00

Hospital Charge Code	60634439
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

SOMA (PLAIN)

Facility

$6.00

Hospital Charge Code	60634439
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

SOMATOMEDIN C

Facility

$613.00

Service Code	HCPCS 84305
Hospital Charge Code	38473084
Hospital Revenue Code	301
Min. Negotiated Rate	$16.24
Max. Negotiated Rate	$306.50
Rate for Payer: Aetna Commercial	$57.83
Rate for Payer: Aetna Medicare Advantage	$68.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.74
Rate for Payer: Cigna Commercial	$306.50
Rate for Payer: Cigna Medicare Advantage	$21.26
Rate for Payer: Clover Medicare Advantage	$20.20
Rate for Payer: EmblemHealth Commercial	$63.78
Rate for Payer: Humana Medicare Advantage	$21.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$17.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.26
Rate for Payer: Wellcare Medicare Advantage	$21.26
Rate for Payer: Wellpoint Medicaid Managed Care	$16.24

SOMATOMEDIN C

Facility

$613.00

Service Code	HCPCS 84305
Hospital Charge Code	38473084
Hospital Revenue Code	301
Min. Negotiated Rate	$91.95
Max. Negotiated Rate	$91.95
Rate for Payer: Qualcare PPO/HMO/WC	$91.95

SOMATOSTATIN

Facility

$129.00

Service Code	HCPCS 84307
Hospital Charge Code	38477152
Hospital Revenue Code	301
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$723.02
Rate for Payer: Aetna Commercial	$49.72
Rate for Payer: Aetna Medicare Advantage	$59.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.99
Rate for Payer: Cigna Commercial	$64.50
Rate for Payer: Cigna Medicare Advantage	$18.28
Rate for Payer: Clover Medicare Advantage	$17.37
Rate for Payer: EmblemHealth Commercial	$54.84
Rate for Payer: Humana Medicare Advantage	$18.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.28
Rate for Payer: Wellcare Medicare Advantage	$18.28
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$723.02
Rate for Payer: Wellpoint Medicaid Managed Care	$3.42

SOMATOSTATIN

Facility

$125.65

Service Code	HCPCS 84307
Hospital Charge Code	39900452
Hospital Revenue Code	301
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$723.02
Rate for Payer: Aetna Commercial	$49.72
Rate for Payer: Aetna Medicare Advantage	$59.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.99
Rate for Payer: Cigna Commercial	$62.83
Rate for Payer: Cigna Medicare Advantage	$18.28
Rate for Payer: Clover Medicare Advantage	$17.37
Rate for Payer: EmblemHealth Commercial	$54.84
Rate for Payer: Humana Medicare Advantage	$18.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.28
Rate for Payer: Wellcare Medicare Advantage	$18.28
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$723.02
Rate for Payer: Wellpoint Medicaid Managed Care	$3.33

SOMATOSTATIN

Facility

$125.65

Service Code	HCPCS 84307
Hospital Charge Code	39900452
Hospital Revenue Code	301
Min. Negotiated Rate	$18.85
Max. Negotiated Rate	$18.85
Rate for Payer: Qualcare PPO/HMO/WC	$18.85

SOMATOSTATIN

Facility

$129.00

Service Code	HCPCS 84307
Hospital Charge Code	38477152
Hospital Revenue Code	301
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$19.35
Rate for Payer: Qualcare PPO/HMO/WC	$19.35

SOMBRERO PATELLA SZ4 7x37MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675368
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

SOMBRERO PATELLA SZ4 7x37MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675368
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

SONGER CRIMP

Facility

$412.50

Hospital Charge Code	270662291
Hospital Revenue Code	272
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$206.25
Rate for Payer: Aetna Commercial	$156.75
Rate for Payer: Aetna Medicare Advantage	$123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.19
Rate for Payer: Cigna Commercial	$206.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.75
Rate for Payer: Oxford Commercial	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$61.88
Rate for Payer: UnitedHealthcare Commercial	$82.50
Rate for Payer: UnitedHealthcare Community & State	$9.94
Rate for Payer: Wellpoint Medicaid Managed Care	$10.93

SONGER CRIMP

Facility

$412.50

Hospital Charge Code	270662291
Hospital Revenue Code	272
Min. Negotiated Rate	$61.88
Max. Negotiated Rate	$61.88
Rate for Payer: Qualcare PPO/HMO/WC	$61.88

Know your out-of-pocket cost for care.

All Charges