Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SPORANOX/100MG/CAP/U/D

Facility

$163.21

Service Code	NDC 50458029001
Hospital Charge Code	60634825
Hospital Revenue Code	250
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$81.61
Rate for Payer: Aetna Commercial	$62.02
Rate for Payer: Aetna Medicare Advantage	$48.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.62
Rate for Payer: Cigna Commercial	$81.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.96
Rate for Payer: Oxford Commercial	$32.64
Rate for Payer: Qualcare PPO/HMO/WC	$24.48
Rate for Payer: UnitedHealthcare Commercial	$32.64
Rate for Payer: UnitedHealthcare Community & State	$3.93
Rate for Payer: Wellpoint Medicaid Managed Care	$4.33

SPORANOX/100MG/CAP/U/D

Facility

$163.21

Service Code	NDC 50458029001
Hospital Charge Code	60634825
Hospital Revenue Code	250
Min. Negotiated Rate	$24.48
Max. Negotiated Rate	$24.48
Rate for Payer: Qualcare PPO/HMO/WC	$24.48

SPORANOX 10MG/ML KIT250ML

Facility

$600.00

Hospital Charge Code	60635363
Hospital Revenue Code	250
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

SPORANOX 10MG/ML KIT250ML

Facility

$600.00

Hospital Charge Code	60635363
Hospital Revenue Code	250
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.00
Rate for Payer: Oxford Commercial	$120.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Commercial	$120.00
Rate for Payer: UnitedHealthcare Community & State	$14.46
Rate for Payer: Wellpoint Medicaid Managed Care	$15.90

SPORTS TAPE

Facility

$44.00

Hospital Charge Code	84202125
Hospital Revenue Code	270
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$22.00
Rate for Payer: Aetna Commercial	$16.72
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.20
Rate for Payer: Oxford Commercial	$8.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$8.80
Rate for Payer: UnitedHealthcare Community & State	$1.06
Rate for Payer: Wellpoint Medicaid Managed Care	$1.17

SPORTS TAPE

Facility

$44.00

Hospital Charge Code	84202125
Hospital Revenue Code	270
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

SPOT (INDIA INK)

Facility

$190.00

Hospital Charge Code	270630596
Hospital Revenue Code	270
Min. Negotiated Rate	$28.50
Max. Negotiated Rate	$28.50
Rate for Payer: Qualcare PPO/HMO/WC	$28.50

SPOT (INDIA INK)

Facility

$190.00

Hospital Charge Code	270630596
Hospital Revenue Code	270
Min. Negotiated Rate	$4.58
Max. Negotiated Rate	$95.00
Rate for Payer: Aetna Commercial	$72.20
Rate for Payer: Aetna Medicare Advantage	$57.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.45
Rate for Payer: Cigna Commercial	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.00
Rate for Payer: Oxford Commercial	$38.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.50
Rate for Payer: UnitedHealthcare Commercial	$38.00
Rate for Payer: UnitedHealthcare Community & State	$4.58
Rate for Payer: Wellpoint Medicaid Managed Care	$5.04

SPOTLIGHT PORTS

Facility

$4,750.00

Hospital Charge Code	270671359
Hospital Revenue Code	272
Min. Negotiated Rate	$114.47
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,425.00
Rate for Payer: Oxford Commercial	$950.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Commercial	$950.00
Rate for Payer: UnitedHealthcare Community & State	$114.47
Rate for Payer: Wellpoint Medicaid Managed Care	$125.88

SPOTLIGHT PORTS

Facility

$4,750.00

Hospital Charge Code	270671359
Hospital Revenue Code	272
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$712.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC

Facility

$32,978.65

Service Code	MSDRG 537
Min. Negotiated Rate	$10,041.58
Max. Negotiated Rate	$32,978.65
Rate for Payer: Aetna Commercial	$22,917.43
Rate for Payer: Aetna Medicare Advantage	$32,978.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,563.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,563.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10,570.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22,563.17
Rate for Payer: Cigna Commercial	$17,858.77
Rate for Payer: Cigna Medicare Advantage	$10,570.08
Rate for Payer: Clover Medicare Advantage	$10,041.58
Rate for Payer: EmblemHealth Commercial	$31,710.24
Rate for Payer: Humana Medicare Advantage	$10,887.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10,570.08
Rate for Payer: Oxford Commercial	$12,835.33
Rate for Payer: UnitedHealthcare Commercial	$22,507.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$10,570.08
Rate for Payer: Wellcare Medicare Advantage	$10,570.08

SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC

Facility

$25,415.40

Service Code	MSDRG 538
Min. Negotiated Rate	$7,738.66
Max. Negotiated Rate	$25,415.40
Rate for Payer: Aetna Commercial	$17,720.59
Rate for Payer: Aetna Medicare Advantage	$25,415.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,515.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,515.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,145.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,515.31
Rate for Payer: Cigna Commercial	$13,479.69
Rate for Payer: Cigna Medicare Advantage	$8,145.96
Rate for Payer: Clover Medicare Advantage	$7,738.66
Rate for Payer: EmblemHealth Commercial	$24,437.88
Rate for Payer: Humana Medicare Advantage	$8,390.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,145.96
Rate for Payer: Oxford Commercial	$9,688.03
Rate for Payer: UnitedHealthcare Commercial	$16,988.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,145.96
Rate for Payer: Wellcare Medicare Advantage	$8,145.96

SPRAYCYTE (FIXATIVE CYTOLOGY)

Facility

$51.35

Hospital Charge Code	270657182
Hospital Revenue Code	270
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$7.70
Rate for Payer: Qualcare PPO/HMO/WC	$7.70

SPRAYCYTE (FIXATIVE CYTOLOGY)

Facility

$51.35

Hospital Charge Code	270657182
Hospital Revenue Code	270
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$25.68
Rate for Payer: Aetna Commercial	$19.51
Rate for Payer: Aetna Medicare Advantage	$15.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.09
Rate for Payer: Cigna Commercial	$25.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.40
Rate for Payer: Oxford Commercial	$10.27
Rate for Payer: Qualcare PPO/HMO/WC	$7.70
Rate for Payer: UnitedHealthcare Commercial	$10.27
Rate for Payer: UnitedHealthcare Community & State	$1.24
Rate for Payer: Wellpoint Medicaid Managed Care	$1.36

SPRAY KIT 800-0200

Facility

$173.65

Hospital Charge Code	270633003
Hospital Revenue Code	272
Min. Negotiated Rate	$26.05
Max. Negotiated Rate	$26.05
Rate for Payer: Qualcare PPO/HMO/WC	$26.05

SPRAY KIT 800-0200

Facility

$173.65

Hospital Charge Code	270633003
Hospital Revenue Code	272
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$86.83
Rate for Payer: Aetna Commercial	$65.99
Rate for Payer: Aetna Medicare Advantage	$52.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.28
Rate for Payer: Cigna Commercial	$86.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.09
Rate for Payer: Oxford Commercial	$34.73
Rate for Payer: Qualcare PPO/HMO/WC	$26.05
Rate for Payer: UnitedHealthcare Commercial	$34.73
Rate for Payer: UnitedHealthcare Community & State	$4.18
Rate for Payer: Wellpoint Medicaid Managed Care	$4.60

SPRAY NOZLE F/USE W/PANASPRAY

Facility

$90.00

Hospital Charge Code	270665000
Hospital Revenue Code	270
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.00
Rate for Payer: Oxford Commercial	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Commercial	$18.00
Rate for Payer: UnitedHealthcare Community & State	$2.17
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

SPRAY NOZLE F/USE W/PANASPRAY

Facility

$90.00

Hospital Charge Code	270665000
Hospital Revenue Code	270
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

SPRAY SILICONE

Facility

$170.00

Hospital Charge Code	270650912
Hospital Revenue Code	272
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$85.00
Rate for Payer: Aetna Commercial	$64.60
Rate for Payer: Aetna Medicare Advantage	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.35
Rate for Payer: Cigna Commercial	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.00
Rate for Payer: Oxford Commercial	$34.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.50
Rate for Payer: UnitedHealthcare Commercial	$34.00
Rate for Payer: UnitedHealthcare Community & State	$4.10
Rate for Payer: Wellpoint Medicaid Managed Care	$4.50

SPRAY SILICONE

Facility

$170.00

Hospital Charge Code	270650912
Hospital Revenue Code	272
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$25.50
Rate for Payer: Qualcare PPO/HMO/WC	$25.50

SPRAY TIP 800-0201

Facility

$161.25

Hospital Charge Code	270633004
Hospital Revenue Code	272
Min. Negotiated Rate	$24.19
Max. Negotiated Rate	$24.19
Rate for Payer: Qualcare PPO/HMO/WC	$24.19

SPRAY TIP 800-0201

Facility

$161.25

Hospital Charge Code	270633004
Hospital Revenue Code	272
Min. Negotiated Rate	$3.89
Max. Negotiated Rate	$80.62
Rate for Payer: Aetna Commercial	$61.27
Rate for Payer: Aetna Medicare Advantage	$48.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.12
Rate for Payer: Cigna Commercial	$80.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.38
Rate for Payer: Oxford Commercial	$32.25
Rate for Payer: Qualcare PPO/HMO/WC	$24.19
Rate for Payer: UnitedHealthcare Commercial	$32.25
Rate for Payer: UnitedHealthcare Community & State	$3.89
Rate for Payer: Wellpoint Medicaid Managed Care	$4.27

SPRAY TIP APPLICATOR 8000202

Facility

$162.50

Hospital Charge Code	270639017
Hospital Revenue Code	272
Min. Negotiated Rate	$24.38
Max. Negotiated Rate	$24.38
Rate for Payer: Qualcare PPO/HMO/WC	$24.38

SPRAY TIP APPLICATOR 8000202

Facility

$162.50

Hospital Charge Code	270639017
Hospital Revenue Code	272
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$81.25
Rate for Payer: Aetna Commercial	$61.75
Rate for Payer: Aetna Medicare Advantage	$48.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.44
Rate for Payer: Cigna Commercial	$81.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Oxford Commercial	$32.50
Rate for Payer: Qualcare PPO/HMO/WC	$24.38
Rate for Payer: UnitedHealthcare Commercial	$32.50
Rate for Payer: UnitedHealthcare Community & State	$3.92
Rate for Payer: Wellpoint Medicaid Managed Care	$4.31

SPRAY TIP GPS APPLICATOR

Facility

$162.50

Hospital Charge Code	270637656
Hospital Revenue Code	272
Min. Negotiated Rate	$24.38
Max. Negotiated Rate	$24.38
Rate for Payer: Qualcare PPO/HMO/WC	$24.38

Know your out-of-pocket cost for care.

All Charges