Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SUCTION SIGMOIDOSCOPE 0033040

Facility

$9.65

Hospital Charge Code	270613332
Hospital Revenue Code	272
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

SUCTION SYSTEM ORTHOPEDIC

Facility

$180.57

Hospital Charge Code	270600351
Hospital Revenue Code	272
Min. Negotiated Rate	$27.09
Max. Negotiated Rate	$27.09
Rate for Payer: Qualcare PPO/HMO/WC	$27.09

SUCTION SYSTEM ORTHOPEDIC

Facility

$180.57

Hospital Charge Code	270600351
Hospital Revenue Code	272
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$90.28
Rate for Payer: Aetna Commercial	$68.62
Rate for Payer: Aetna Medicare Advantage	$54.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.05
Rate for Payer: Cigna Commercial	$90.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.17
Rate for Payer: Oxford Commercial	$36.11
Rate for Payer: Qualcare PPO/HMO/WC	$27.09
Rate for Payer: UnitedHealthcare Commercial	$36.11
Rate for Payer: UnitedHealthcare Community & State	$4.35
Rate for Payer: Wellpoint Medicaid Managed Care	$4.79

SUCTION TIP YANKAUER

Facility

$5.65

Hospital Charge Code	270061415
Hospital Revenue Code	272
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

SUCTION TIP YANKAUER

Facility

$5.65

Hospital Charge Code	270061415
Hospital Revenue Code	272
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

SUCTION TUBE KAMVAC MINI

Facility

$47.00

Hospital Charge Code	270332484
Hospital Revenue Code	272
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$23.50
Rate for Payer: Aetna Commercial	$17.86
Rate for Payer: Aetna Medicare Advantage	$14.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.98
Rate for Payer: Cigna Commercial	$23.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.10
Rate for Payer: Oxford Commercial	$9.40
Rate for Payer: Qualcare PPO/HMO/WC	$7.05
Rate for Payer: UnitedHealthcare Commercial	$9.40
Rate for Payer: UnitedHealthcare Community & State	$1.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

SUCTION TUBE KAMVAC MINI

Facility

$47.00

Hospital Charge Code	270332484
Hospital Revenue Code	272
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$7.05
Rate for Payer: Qualcare PPO/HMO/WC	$7.05

SUCTION YANKAUER

Facility

$1.60

Hospital Charge Code	270649944
Hospital Revenue Code	272
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.80
Rate for Payer: Aetna Commercial	$0.61
Rate for Payer: Aetna Medicare Advantage	$0.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.41
Rate for Payer: Cigna Commercial	$0.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.48
Rate for Payer: Oxford Commercial	$0.32
Rate for Payer: Qualcare PPO/HMO/WC	$0.24
Rate for Payer: UnitedHealthcare Commercial	$0.32
Rate for Payer: UnitedHealthcare Community & State	$0.04
Rate for Payer: Wellpoint Medicaid Managed Care	$0.04

SUCTION YANKAUER

Facility

$1.60

Hospital Charge Code	270649944
Hospital Revenue Code	272
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.24
Rate for Payer: Qualcare PPO/HMO/WC	$0.24

SUFENTNL CIT INJ 50MCG/ML 1ML

Facility

$95.40

Hospital Charge Code	6005078
Hospital Revenue Code	250
Min. Negotiated Rate	$14.31
Max. Negotiated Rate	$14.31
Rate for Payer: Qualcare PPO/HMO/WC	$14.31

SUFENTNL CIT INJ 50MCG/ML 1ML

Facility

$95.40

Hospital Charge Code	6005078
Hospital Revenue Code	250
Min. Negotiated Rate	$2.30
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna Commercial	$36.25
Rate for Payer: Aetna Medicare Advantage	$28.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.33
Rate for Payer: Cigna Commercial	$47.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.62
Rate for Payer: Oxford Commercial	$19.08
Rate for Payer: Qualcare PPO/HMO/WC	$14.31
Rate for Payer: UnitedHealthcare Commercial	$19.08
Rate for Payer: UnitedHealthcare Community & State	$2.30
Rate for Payer: Wellpoint Medicaid Managed Care	$2.53

SUFENTNL CIT INJ 50MCG/ML 2ML

Facility

$174.75

Hospital Charge Code	6005086
Hospital Revenue Code	250
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$87.38
Rate for Payer: Aetna Commercial	$66.41
Rate for Payer: Aetna Medicare Advantage	$52.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.56
Rate for Payer: Cigna Commercial	$87.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.42
Rate for Payer: Oxford Commercial	$34.95
Rate for Payer: Qualcare PPO/HMO/WC	$26.21
Rate for Payer: UnitedHealthcare Commercial	$34.95
Rate for Payer: UnitedHealthcare Community & State	$4.21
Rate for Payer: Wellpoint Medicaid Managed Care	$4.63

SUFENTNL CIT INJ 50MCG/ML 2ML

Facility

$174.75

Hospital Charge Code	6005086
Hospital Revenue Code	250
Min. Negotiated Rate	$26.21
Max. Negotiated Rate	$26.21
Rate for Payer: Qualcare PPO/HMO/WC	$26.21

SUFENTNL CIT INJ 50MCG/ML 5ML

Facility

$357.15

Hospital Charge Code	6005094
Hospital Revenue Code	250
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$178.57
Rate for Payer: Aetna Commercial	$135.72
Rate for Payer: Aetna Medicare Advantage	$107.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.07
Rate for Payer: Cigna Commercial	$178.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.14
Rate for Payer: Oxford Commercial	$71.43
Rate for Payer: Qualcare PPO/HMO/WC	$53.57
Rate for Payer: UnitedHealthcare Commercial	$71.43
Rate for Payer: UnitedHealthcare Community & State	$8.61
Rate for Payer: Wellpoint Medicaid Managed Care	$9.46

SUFENTNL CIT INJ 50MCG/ML 5ML

Facility

$357.15

Hospital Charge Code	6005094
Hospital Revenue Code	250
Min. Negotiated Rate	$53.57
Max. Negotiated Rate	$53.57
Rate for Payer: Qualcare PPO/HMO/WC	$53.57

SUGAMMADEX 200MG VIAL

Facility

$763.80

Service Code	NDC 6542312
Hospital Charge Code	606390161
Hospital Revenue Code	250
Min. Negotiated Rate	$18.41
Max. Negotiated Rate	$381.90
Rate for Payer: Aetna Commercial	$290.24
Rate for Payer: Aetna Medicare Advantage	$229.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$194.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$194.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$194.77
Rate for Payer: Cigna Commercial	$381.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.14
Rate for Payer: Oxford Commercial	$152.76
Rate for Payer: Qualcare PPO/HMO/WC	$114.57
Rate for Payer: UnitedHealthcare Commercial	$152.76
Rate for Payer: UnitedHealthcare Community & State	$18.41
Rate for Payer: Wellpoint Medicaid Managed Care	$20.24

SUGAMMADEX 200MG VIAL

Facility

$763.80

Service Code	NDC 6542312
Hospital Charge Code	606390161
Hospital Revenue Code	250
Min. Negotiated Rate	$114.57
Max. Negotiated Rate	$114.57
Rate for Payer: Qualcare PPO/HMO/WC	$114.57

SUGAMMADEX 500MG VIAL

Facility

$1,398.96

Service Code	NDC 6542315
Hospital Charge Code	606390162
Hospital Revenue Code	250
Min. Negotiated Rate	$209.84
Max. Negotiated Rate	$209.84
Rate for Payer: Qualcare PPO/HMO/WC	$209.84

SUGAMMADEX 500MG VIAL

Facility

$1,398.96

Service Code	NDC 6542315
Hospital Charge Code	606390162
Hospital Revenue Code	250
Min. Negotiated Rate	$33.71
Max. Negotiated Rate	$699.48
Rate for Payer: Aetna Commercial	$531.60
Rate for Payer: Aetna Medicare Advantage	$419.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$356.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$356.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$356.73
Rate for Payer: Cigna Commercial	$699.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$419.69
Rate for Payer: Oxford Commercial	$279.79
Rate for Payer: Qualcare PPO/HMO/WC	$209.84
Rate for Payer: UnitedHealthcare Commercial	$279.79
Rate for Payer: UnitedHealthcare Community & State	$33.71
Rate for Payer: Wellpoint Medicaid Managed Care	$37.07

SUGAR SINGLE QUAN EACH SPECI

Facility

$454.00

Service Code	HCPCS 84378
Hospital Charge Code	3008255
Hospital Revenue Code	301
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$227.00
Rate for Payer: Aetna Commercial	$31.36
Rate for Payer: Aetna Medicare Advantage	$37.36
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) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.62
Rate for Payer: Cigna Commercial	$227.00
Rate for Payer: Cigna Medicare Advantage	$11.53
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$136.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$68.10
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Medicare Advantage	$11.53
Rate for Payer: Wellpoint Medicaid Managed Care	$12.03

SUGAR SINGLE QUAN EACH SPECI

Facility

$454.00

Service Code	HCPCS 84378
Hospital Charge Code	3008255
Hospital Revenue Code	301
Min. Negotiated Rate	$68.10
Max. Negotiated Rate	$68.10
Rate for Payer: Qualcare PPO/HMO/WC	$68.10

SUGARS MULT QUAL @ SPECIMENT

Facility

$39.00

Service Code	HCPCS 84377
Hospital Charge Code	38477044
Hospital Revenue Code	301
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.96
Rate for Payer: Aetna Medicare Advantage	$17.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.85
Rate for Payer: Cigna Commercial	$19.50
Rate for Payer: Cigna Medicare Advantage	$5.50
Rate for Payer: Clover Medicare Advantage	$5.22
Rate for Payer: EmblemHealth Commercial	$16.50
Rate for Payer: Humana Medicare Advantage	$5.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.50
Rate for Payer: Wellcare Medicare Advantage	$5.50
Rate for Payer: Wellpoint Medicaid Managed Care	$1.03

SUGARS MULT QUAL @ SPECIMENT

Facility

$39.00

Service Code	HCPCS 84377
Hospital Charge Code	38477044
Hospital Revenue Code	301
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$5.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.85

SUGARS SING QUAL @ SPECIMEN

Facility

$39.00

Service Code	HCPCS 84376
Hospital Charge Code	38477043
Hospital Revenue Code	301
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.96
Rate for Payer: Aetna Medicare Advantage	$17.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.85
Rate for Payer: Cigna Commercial	$19.50
Rate for Payer: Cigna Medicare Advantage	$5.50
Rate for Payer: Clover Medicare Advantage	$5.22
Rate for Payer: EmblemHealth Commercial	$16.50
Rate for Payer: Humana Medicare Advantage	$5.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.50
Rate for Payer: Wellcare Medicare Advantage	$5.50
Rate for Payer: Wellpoint Medicaid Managed Care	$1.03

SUGARS SING QUAL @ SPECIMEN

Facility

$39.00

Service Code	HCPCS 84376
Hospital Charge Code	38477043
Hospital Revenue Code	301
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$5.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.85

Know your out-of-pocket cost for care.

All Charges