Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SUBTALAR MBA 10MM

Facility

$5,000.00

Service Code	HCPCS L8699
Hospital Charge Code	270690965
Hospital Revenue Code	278
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

SUBTALAR MBA 10MM

Facility

$5,000.00

Service Code	HCPCS L8699
Hospital Charge Code	270690965
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

SUBTALAR MBA 8MM IMPLANT

Facility

$12,495.00

Hospital Charge Code	270667235
Hospital Revenue Code	278
Min. Negotiated Rate	$301.13
Max. Negotiated Rate	$6,247.50
Rate for Payer: Aetna Commercial	$4,748.10
Rate for Payer: Aetna Medicare Advantage	$3,748.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,186.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,186.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,499.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,186.22
Rate for Payer: Cigna Commercial	$6,247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,023.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,748.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,874.25
Rate for Payer: UnitedHealthcare Community & State	$301.13
Rate for Payer: Wellpoint Medicaid Managed Care	$331.12

SUBTALAR MBA 8MM IMPLANT

Facility

$12,495.00

Hospital Charge Code	270667235
Hospital Revenue Code	278
Min. Negotiated Rate	$1,874.25
Max. Negotiated Rate	$3,023.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,499.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,023.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,748.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,874.25

SUBTALAR PITSTOP 12.7X10MM

Facility

$17,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270692058
Hospital Revenue Code	278
Min. Negotiated Rate	$421.15
Max. Negotiated Rate	$8,737.50
Rate for Payer: Aetna Commercial	$6,640.50
Rate for Payer: Aetna Medicare Advantage	$5,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,456.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,456.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,456.12
Rate for Payer: Cigna Commercial	$8,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,228.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,844.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,621.25
Rate for Payer: UnitedHealthcare Community & State	$421.15
Rate for Payer: Wellpoint Medicaid Managed Care	$463.09

SUBTALAR PITSTOP 12.7X10MM

Facility

$17,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270692058
Hospital Revenue Code	278
Min. Negotiated Rate	$2,621.25
Max. Negotiated Rate	$4,228.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,228.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,844.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,621.25

SUBTOTAL ABD HYSTERECTOMY

Facility

$15,145.47

Service Code	HCPCS 58180
Hospital Charge Code	1600000563
Hospital Revenue Code	360
Min. Negotiated Rate	$2,271.82
Max. Negotiated Rate	$2,271.82
Rate for Payer: Qualcare PPO/HMO/WC	$2,271.82

SUBTOTAL ABD HYSTERECTOMY

Facility

$15,145.47

Service Code	HCPCS 58150
Hospital Charge Code	1600000313
Hospital Revenue Code	360
Min. Negotiated Rate	$365.01
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$5,755.28
Rate for Payer: Aetna Medicare Advantage	$4,543.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,862.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,862.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,862.09
Rate for Payer: Cigna Commercial	$7,572.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,543.64
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,271.82
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$365.01
Rate for Payer: Wellpoint Medicaid Managed Care	$401.35

SUBTOTAL ABD HYSTERECTOMY

Facility

$15,145.47

Service Code	HCPCS 58150
Hospital Charge Code	1600000313
Hospital Revenue Code	360
Min. Negotiated Rate	$2,271.82
Max. Negotiated Rate	$2,271.82
Rate for Payer: Qualcare PPO/HMO/WC	$2,271.82

SUBTOTAL ABD HYSTERECTOMY

Facility

$15,145.47

Service Code	HCPCS 58180
Hospital Charge Code	1600000563
Hospital Revenue Code	360
Min. Negotiated Rate	$365.01
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$5,755.28
Rate for Payer: Aetna Medicare Advantage	$4,543.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,862.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,862.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,862.09
Rate for Payer: Cigna Commercial	$7,572.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,543.64
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,271.82
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$365.01
Rate for Payer: Wellpoint Medicaid Managed Care	$401.35

SUCCINYLCHOLINE

Facility

$47.35

Hospital Charge Code	270656764
Hospital Revenue Code	270
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$7.10
Rate for Payer: Qualcare PPO/HMO/WC	$7.10

SUCCINYLCHOLINE

Facility

$47.35

Hospital Charge Code	270656764
Hospital Revenue Code	270
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$23.68
Rate for Payer: Aetna Commercial	$17.99
Rate for Payer: Aetna Medicare Advantage	$14.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.07
Rate for Payer: Cigna Commercial	$23.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.21
Rate for Payer: Oxford Commercial	$9.47
Rate for Payer: Qualcare PPO/HMO/WC	$7.10
Rate for Payer: UnitedHealthcare Commercial	$9.47
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

SUCCINYLCHOLINE 20 MG/ML INJ

Facility

$154.23

Service Code	HCPCS J0330
Hospital Charge Code	6007538
Hospital Revenue Code	636
Min. Negotiated Rate	$3.72
Max. Negotiated Rate	$77.11
Rate for Payer: Aetna Commercial	$58.61
Rate for Payer: Aetna Medicare Advantage	$46.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.33
Rate for Payer: Cigna Commercial	$77.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.32
Rate for Payer: Qualcare PPO/HMO/WC	$23.13
Rate for Payer: UnitedHealthcare Community & State	$3.72
Rate for Payer: Wellpoint Medicaid Managed Care	$4.09

SUCCINYLCHOLINE 20 MG/ML INJ

Facility

$154.23

Service Code	HCPCS J0330
Hospital Charge Code	6007538
Hospital Revenue Code	636
Min. Negotiated Rate	$23.13
Max. Negotiated Rate	$37.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.32
Rate for Payer: Qualcare PPO/HMO/WC	$23.13

SUCCINYLCHOLINE CHLR FLO-PACK

Facility

$4.50

Hospital Charge Code	6013247
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

SUCCINYLCHOLINE CHLR FLO-PACK

Facility

$4.50

Hospital Charge Code	6013247
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.71
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.15
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.35
Rate for Payer: Oxford Commercial	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$0.90
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

SUCCINYLCHOLINE CHLR VIAL

Facility

$4.50

Hospital Charge Code	6013254
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

SUCCINYLCHOLINE CHLR VIAL

Facility

$4.50

Hospital Charge Code	6013254
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.71
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.15
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.35
Rate for Payer: Oxford Commercial	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$0.90
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

SUCCINYLCHOLINE INJ 1GM

Facility

$5.65

Hospital Charge Code	60627491
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$2.15
Rate for Payer: Aetna Medicare Advantage	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.70
Rate for Payer: Oxford Commercial	$1.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$1.13
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

SUCCINYLCHOLINE INJ 1GM

Facility

$5.65

Hospital Charge Code	60627491
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

SUCRALFATE 1 GRAM/10ML

Facility

$67.40

Service Code	NDC 121074710
Hospital Charge Code	60629338
Hospital Revenue Code	250
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$33.70
Rate for Payer: Aetna Commercial	$25.61
Rate for Payer: Aetna Medicare Advantage	$20.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.19
Rate for Payer: Cigna Commercial	$33.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.22
Rate for Payer: Oxford Commercial	$13.48
Rate for Payer: Qualcare PPO/HMO/WC	$10.11
Rate for Payer: UnitedHealthcare Commercial	$13.48
Rate for Payer: UnitedHealthcare Community & State	$1.62
Rate for Payer: Wellpoint Medicaid Managed Care	$1.79

SUCRALFATE 1 GRAM/10ML

Facility

$67.40

Service Code	NDC 121074710
Hospital Charge Code	60629338
Hospital Revenue Code	250
Min. Negotiated Rate	$10.11
Max. Negotiated Rate	$10.11
Rate for Payer: Qualcare PPO/HMO/WC	$10.11

SUCRALFATE 1 G TAB

Facility

$5.36

Service Code	NDC 93221001
Hospital Charge Code	6016521
Hospital Revenue Code	251
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.68
Rate for Payer: Aetna Commercial	$2.04
Rate for Payer: Aetna Medicare Advantage	$1.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.37
Rate for Payer: Cigna Commercial	$2.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.61
Rate for Payer: Oxford Commercial	$1.07
Rate for Payer: Qualcare PPO/HMO/WC	$0.80
Rate for Payer: UnitedHealthcare Commercial	$1.07
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

SUCRALFATE 1 G TAB

Facility

$5.36

Service Code	NDC 93221001
Hospital Charge Code	6016521
Hospital Revenue Code	251
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.80

SUCRALFATE/LIDOC VISC 120ML

Facility

$66.45

Hospital Charge Code	60628912
Hospital Revenue Code	250
Min. Negotiated Rate	$9.97
Max. Negotiated Rate	$9.97
Rate for Payer: Qualcare PPO/HMO/WC	$9.97

Know your out-of-pocket cost for care.

All Charges