Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SUCRALFATE/LIDOC VISC 120ML

Facility

$66.45

Hospital Charge Code	60628912
Hospital Revenue Code	250
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$33.23
Rate for Payer: Aetna Commercial	$25.25
Rate for Payer: Aetna Medicare Advantage	$19.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.94
Rate for Payer: Cigna Commercial	$33.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.93
Rate for Payer: Oxford Commercial	$13.29
Rate for Payer: Qualcare PPO/HMO/WC	$9.97
Rate for Payer: UnitedHealthcare Commercial	$13.29
Rate for Payer: UnitedHealthcare Community & State	$1.60
Rate for Payer: Wellpoint Medicaid Managed Care	$1.76

SUCRALFATE/MAGALUM/LIDOC 120ML

Facility

$194.45

Hospital Charge Code	60628931
Hospital Revenue Code	250
Min. Negotiated Rate	$4.69
Max. Negotiated Rate	$97.22
Rate for Payer: Aetna Commercial	$73.89
Rate for Payer: Aetna Medicare Advantage	$58.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.58
Rate for Payer: Cigna Commercial	$97.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.34
Rate for Payer: Oxford Commercial	$38.89
Rate for Payer: Qualcare PPO/HMO/WC	$29.17
Rate for Payer: UnitedHealthcare Commercial	$38.89
Rate for Payer: UnitedHealthcare Community & State	$4.69
Rate for Payer: Wellpoint Medicaid Managed Care	$5.15

SUCRALFATE/MAGALUM/LIDOC 120ML

Facility

$194.45

Hospital Charge Code	60628931
Hospital Revenue Code	250
Min. Negotiated Rate	$29.17
Max. Negotiated Rate	$29.17
Rate for Payer: Qualcare PPO/HMO/WC	$29.17

SUCRALFATE SUSP 1GM/10ML

Facility

$15.00

Hospital Charge Code	60635055
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

SUCRALFATE SUSP 1GM/10ML

Facility

$15.00

Hospital Charge Code	60635055
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$3.00
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

SUCROSE HE HEMOLYSINS/AGGLUTIN

Facility

$390.00

Service Code	HCPCS 86940
Hospital Charge Code	3035099
Hospital Revenue Code	302
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$23.85
Rate for Payer: Aetna Medicare Advantage	$28.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.66
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$8.77
Rate for Payer: Clover Medicare Advantage	$8.33
Rate for Payer: EmblemHealth Commercial	$26.31
Rate for Payer: Humana Medicare Advantage	$9.03
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.77
Rate for Payer: Wellcare Medicare Advantage	$8.77
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

SUCROSE HE HEMOLYSINS/AGGLUTIN

Facility

$390.00

Service Code	HCPCS 86940
Hospital Charge Code	3035099
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SUCTION*******

Facility

$22.00

Hospital Charge Code	9500060
Hospital Revenue Code	279
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$3.30

SUCTION*******

Facility

$22.00

Hospital Charge Code	9500060
Hospital Revenue Code	279
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$11.00
Rate for Payer: Aetna Commercial	$8.36
Rate for Payer: Aetna Medicare Advantage	$6.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.61
Rate for Payer: Cigna Commercial	$11.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.60
Rate for Payer: Oxford Commercial	$4.40
Rate for Payer: Qualcare PPO/HMO/WC	$3.30
Rate for Payer: UnitedHealthcare Commercial	$4.40
Rate for Payer: UnitedHealthcare Community & State	$0.53
Rate for Payer: Wellpoint Medicaid Managed Care	$0.58

SUCTION CATH *******

Facility

$7.00

Hospital Charge Code	8001612
Hospital Revenue Code	279
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

SUCTION CATH *******

Facility

$7.00

Hospital Charge Code	8001612
Hospital Revenue Code	279
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

SUCTION COAG L HOOK 5 MM X 32

Facility

$2,086.90

Hospital Charge Code	270688620
Hospital Revenue Code	272
Min. Negotiated Rate	$50.29
Max. Negotiated Rate	$1,043.45
Rate for Payer: Aetna Commercial	$793.02
Rate for Payer: Aetna Medicare Advantage	$626.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$532.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$532.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$532.16
Rate for Payer: Cigna Commercial	$1,043.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$626.07
Rate for Payer: Oxford Commercial	$417.38
Rate for Payer: Qualcare PPO/HMO/WC	$313.04
Rate for Payer: UnitedHealthcare Commercial	$417.38
Rate for Payer: UnitedHealthcare Community & State	$50.29
Rate for Payer: Wellpoint Medicaid Managed Care	$55.30

SUCTION COAG L HOOK 5 MM X 32

Facility

$2,086.90

Hospital Charge Code	270688620
Hospital Revenue Code	272
Min. Negotiated Rate	$313.04
Max. Negotiated Rate	$313.04
Rate for Payer: Qualcare PPO/HMO/WC	$313.04

SUCTION COAGULATOR

Facility

$58.15

Hospital Charge Code	270650795
Hospital Revenue Code	272
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$29.07
Rate for Payer: Aetna Commercial	$22.10
Rate for Payer: Aetna Medicare Advantage	$17.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.83
Rate for Payer: Cigna Commercial	$29.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.45
Rate for Payer: Oxford Commercial	$11.63
Rate for Payer: Qualcare PPO/HMO/WC	$8.72
Rate for Payer: UnitedHealthcare Commercial	$11.63
Rate for Payer: UnitedHealthcare Community & State	$1.40
Rate for Payer: Wellpoint Medicaid Managed Care	$1.54

SUCTION COAGULATOR

Facility

$58.15

Hospital Charge Code	270650795
Hospital Revenue Code	272
Min. Negotiated Rate	$8.72
Max. Negotiated Rate	$8.72
Rate for Payer: Qualcare PPO/HMO/WC	$8.72

SUCTION COAGULATOR 10FR 6

Facility

$70.54

Hospital Charge Code	270651005
Hospital Revenue Code	272
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$35.27
Rate for Payer: Aetna Commercial	$26.81
Rate for Payer: Aetna Medicare Advantage	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.99
Rate for Payer: Cigna Commercial	$35.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.16
Rate for Payer: Oxford Commercial	$14.11
Rate for Payer: Qualcare PPO/HMO/WC	$10.58
Rate for Payer: UnitedHealthcare Commercial	$14.11
Rate for Payer: UnitedHealthcare Community & State	$1.70
Rate for Payer: Wellpoint Medicaid Managed Care	$1.87

SUCTION COAGULATOR 10FR 6

Facility

$70.54

Hospital Charge Code	270651005
Hospital Revenue Code	272
Min. Negotiated Rate	$10.58
Max. Negotiated Rate	$10.58
Rate for Payer: Qualcare PPO/HMO/WC	$10.58

SUCTION COAGULATOR 6 10FR

Facility

$108.00

Hospital Charge Code	270600315
Hospital Revenue Code	272
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$16.20
Rate for Payer: Qualcare PPO/HMO/WC	$16.20

SUCTION COAGULATOR 6 10FR

Facility

$108.00

Hospital Charge Code	270600315
Hospital Revenue Code	272
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna Commercial	$41.04
Rate for Payer: Aetna Medicare Advantage	$32.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.54
Rate for Payer: Cigna Commercial	$54.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.40
Rate for Payer: Oxford Commercial	$21.60
Rate for Payer: Qualcare PPO/HMO/WC	$16.20
Rate for Payer: UnitedHealthcare Commercial	$21.60
Rate for Payer: UnitedHealthcare Community & State	$2.60
Rate for Payer: Wellpoint Medicaid Managed Care	$2.86

SUCTION COAGULATOR 8FR W/HANDS

Facility

$57.00

Hospital Charge Code	270677264
Hospital Revenue Code	272
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$8.55
Rate for Payer: Qualcare PPO/HMO/WC	$8.55

SUCTION COAGULATOR 8FR W/HANDS

Facility

$57.00

Hospital Charge Code	270677264
Hospital Revenue Code	272
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$28.50
Rate for Payer: Aetna Commercial	$21.66
Rate for Payer: Aetna Medicare Advantage	$17.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.54
Rate for Payer: Cigna Commercial	$28.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.10
Rate for Payer: Oxford Commercial	$11.40
Rate for Payer: Qualcare PPO/HMO/WC	$8.55
Rate for Payer: UnitedHealthcare Commercial	$11.40
Rate for Payer: UnitedHealthcare Community & State	$1.37
Rate for Payer: Wellpoint Medicaid Managed Care	$1.51

SUCTION COAGULATOR VALLEYLAB**

Facility

$30.00

Hospital Charge Code	1608009
Hospital Revenue Code	272
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna Commercial	$11.40
Rate for Payer: Aetna Medicare Advantage	$9.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.65
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.00
Rate for Payer: Oxford Commercial	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$6.00
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

SUCTION COAGULATOR VALLEYLAB**

Facility

$30.00

Hospital Charge Code	1608009
Hospital Revenue Code	272
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

SUCTION COLLECTION BOTTLE

Facility

$48.00

Hospital Charge Code	270331831
Hospital Revenue Code	272
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

SUCTION COLLECTION BOTTLE

Facility

$48.00

Hospital Charge Code	270331831
Hospital Revenue Code	272
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$18.24
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.40
Rate for Payer: Oxford Commercial	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$9.60
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

Know your out-of-pocket cost for care.

All Charges