Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SONIC TURBO MINI FLARED

Facility

$375.00

Hospital Charge Code	270660134
Hospital Revenue Code	272
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.50
Rate for Payer: Oxford Commercial	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Commercial	$75.00
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

SONIC TURBO MINI FLARED

Facility

$375.00

Hospital Charge Code	270660134
Hospital Revenue Code	272
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

SONOGRAM ABDOMINAL

Facility

$2,499.00

Service Code	HCPCS 76700
Hospital Charge Code	83653025
Hospital Revenue Code	402
Min. Negotiated Rate	$374.85
Max. Negotiated Rate	$374.85
Rate for Payer: Qualcare PPO/HMO/WC	$374.85

SONOGRAM ABDOMINAL

Facility

$2,499.00

Service Code	HCPCS 76700
Hospital Charge Code	83653025
Hospital Revenue Code	402
Min. Negotiated Rate	$60.23
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$749.70
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$374.85
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$60.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$66.22

SONOGRAM OB- COMPLETE

Facility

$1,754.00

Service Code	HCPCS 76805
Hospital Charge Code	83653040
Hospital Revenue Code	402
Min. Negotiated Rate	$263.10
Max. Negotiated Rate	$263.10
Rate for Payer: Qualcare PPO/HMO/WC	$263.10

SONOGRAM OB- COMPLETE

Facility

$1,754.00

Service Code	HCPCS 76805
Hospital Charge Code	83653040
Hospital Revenue Code	402
Min. Negotiated Rate	$42.27
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$526.20
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$263.10
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$42.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$46.48

SONOGRAM OB-REPEAT EA ADDTL FE

Facility

$1,278.20

Service Code	HCPCS 76816
Hospital Charge Code	83653075
Hospital Revenue Code	402
Min. Negotiated Rate	$191.73
Max. Negotiated Rate	$191.73
Rate for Payer: Qualcare PPO/HMO/WC	$191.73

SONOGRAM OB-REPEAT EA ADDTL FE

Facility

$1,278.20

Service Code	HCPCS 76816
Hospital Charge Code	83653075
Hospital Revenue Code	402
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$67.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$383.46
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$191.73
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$30.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.67
Rate for Payer: Wellpoint Medicaid Managed Care	$33.87

SORB-10 RENAL

Facility

$16.85

Hospital Charge Code	270606196
Hospital Revenue Code	272
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$8.43
Rate for Payer: Aetna Commercial	$6.40
Rate for Payer: Aetna Medicare Advantage	$5.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.30
Rate for Payer: Cigna Commercial	$8.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.05
Rate for Payer: Oxford Commercial	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$2.53
Rate for Payer: UnitedHealthcare Commercial	$3.37
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

SORB-10 RENAL

Facility

$16.85

Hospital Charge Code	270606196
Hospital Revenue Code	272
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

SORBAFIX 30-SHT ABSRBBLE FIX

Facility

$2,700.00

Hospital Charge Code	270645935
Hospital Revenue Code	272
Min. Negotiated Rate	$65.07
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$1,026.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$810.00
Rate for Payer: Oxford Commercial	$540.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$540.00
Rate for Payer: UnitedHealthcare Community & State	$65.07
Rate for Payer: Wellpoint Medicaid Managed Care	$71.55

SORBAFIX 30-SHT ABSRBBLE FIX

Facility

$2,700.00

Hospital Charge Code	270645935
Hospital Revenue Code	272
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

SORB CARTRIDGE HI****

Facility

$281.00

Hospital Charge Code	270610922
Hospital Revenue Code	272
Min. Negotiated Rate	$42.15
Max. Negotiated Rate	$42.15
Rate for Payer: Qualcare PPO/HMO/WC	$42.15

SORB CARTRIDGE HI****

Facility

$281.00

Hospital Charge Code	270610922
Hospital Revenue Code	272
Min. Negotiated Rate	$6.77
Max. Negotiated Rate	$140.50
Rate for Payer: Aetna Commercial	$106.78
Rate for Payer: Aetna Medicare Advantage	$84.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.66
Rate for Payer: Cigna Commercial	$140.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.30
Rate for Payer: Oxford Commercial	$56.20
Rate for Payer: Qualcare PPO/HMO/WC	$42.15
Rate for Payer: UnitedHealthcare Commercial	$56.20
Rate for Payer: UnitedHealthcare Community & State	$6.77
Rate for Payer: Wellpoint Medicaid Managed Care	$7.45

SORB HI CARTRIDGE

Facility

$446.45

Hospital Charge Code	8200099
Hospital Revenue Code	271
Min. Negotiated Rate	$66.97
Max. Negotiated Rate	$66.97
Rate for Payer: Qualcare PPO/HMO/WC	$66.97

SORB HI CARTRIDGE

Facility

$446.45

Hospital Charge Code	8200099
Hospital Revenue Code	271
Min. Negotiated Rate	$10.76
Max. Negotiated Rate	$223.22
Rate for Payer: Aetna Commercial	$169.65
Rate for Payer: Aetna Medicare Advantage	$133.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.84
Rate for Payer: Cigna Commercial	$223.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.94
Rate for Payer: Oxford Commercial	$89.29
Rate for Payer: Qualcare PPO/HMO/WC	$66.97
Rate for Payer: UnitedHealthcare Commercial	$89.29
Rate for Payer: UnitedHealthcare Community & State	$10.76
Rate for Payer: Wellpoint Medicaid Managed Care	$11.83

SORBITOL 70%/30ML

Facility

$27.14

Service Code	NDC 46287050030
Hospital Charge Code	60634966
Hospital Revenue Code	250
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$4.07
Rate for Payer: Qualcare PPO/HMO/WC	$4.07

SORBITOL 70%/30ML

Facility

$27.14

Service Code	NDC 46287050030
Hospital Charge Code	60634966
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$13.57
Rate for Payer: Aetna Commercial	$10.31
Rate for Payer: Aetna Medicare Advantage	$8.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.92
Rate for Payer: Cigna Commercial	$13.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.14
Rate for Payer: Oxford Commercial	$5.43
Rate for Payer: Qualcare PPO/HMO/WC	$4.07
Rate for Payer: UnitedHealthcare Commercial	$5.43
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

SORBITOL 70%/473ML

Facility

$39.40

Service Code	NDC 10135013708
Hospital Charge Code	60633913
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$19.70
Rate for Payer: Aetna Commercial	$14.97
Rate for Payer: Aetna Medicare Advantage	$11.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.05
Rate for Payer: Cigna Commercial	$19.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.82
Rate for Payer: Oxford Commercial	$7.88
Rate for Payer: Qualcare PPO/HMO/WC	$5.91
Rate for Payer: UnitedHealthcare Commercial	$7.88
Rate for Payer: UnitedHealthcare Community & State	$0.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1.04

SORBITOL 70%/473ML

Facility

$39.40

Service Code	NDC 10135013708
Hospital Charge Code	60633913
Hospital Revenue Code	250
Min. Negotiated Rate	$5.91
Max. Negotiated Rate	$5.91
Rate for Payer: Qualcare PPO/HMO/WC	$5.91

SORBITOL LQ 70% 16OZ

Facility

$2.45

Hospital Charge Code	6005045
Hospital Revenue Code	251
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

SORBITOL LQ 70% 16OZ

Facility

$2.45

Hospital Charge Code	6005045
Hospital Revenue Code	251
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.93
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.74
Rate for Payer: Oxford Commercial	$0.49
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$0.49
Rate for Payer: UnitedHealthcare Community & State	$0.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.06

SORBITOL MANNITOL IRRIG 3000ml

Facility

$37.45

Hospital Charge Code	270650083
Hospital Revenue Code	270
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$18.73
Rate for Payer: Aetna Commercial	$14.23
Rate for Payer: Aetna Medicare Advantage	$11.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.55
Rate for Payer: Cigna Commercial	$18.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.23
Rate for Payer: Oxford Commercial	$7.49
Rate for Payer: Qualcare PPO/HMO/WC	$5.62
Rate for Payer: UnitedHealthcare Commercial	$7.49
Rate for Payer: UnitedHealthcare Community & State	$0.90
Rate for Payer: Wellpoint Medicaid Managed Care	$0.99

SORBITOL MANNITOL IRRIG 3000ml

Facility

$37.45

Hospital Charge Code	270650083
Hospital Revenue Code	270
Min. Negotiated Rate	$5.62
Max. Negotiated Rate	$5.62
Rate for Payer: Qualcare PPO/HMO/WC	$5.62

SORBITOL-MANNITOL IRRIG 3000ml

Facility

$61.80

Hospital Charge Code	270649323
Hospital Revenue Code	272
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$30.90
Rate for Payer: Aetna Commercial	$23.48
Rate for Payer: Aetna Medicare Advantage	$18.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.76
Rate for Payer: Cigna Commercial	$30.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.54
Rate for Payer: Oxford Commercial	$12.36
Rate for Payer: Qualcare PPO/HMO/WC	$9.27
Rate for Payer: UnitedHealthcare Commercial	$12.36
Rate for Payer: UnitedHealthcare Community & State	$1.49
Rate for Payer: Wellpoint Medicaid Managed Care	$1.64

Know your out-of-pocket cost for care.

All Charges