Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SUGAR WATER TEST (BLOOD)

Facility

$67.25

Service Code	HCPCS 86941
Hospital Charge Code	3008257
Hospital Revenue Code	302
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$10.09
Rate for Payer: Qualcare PPO/HMO/WC	$10.09

SUGAR WATER TEST (BLOOD)

Facility

$67.25

Service Code	HCPCS 86941
Hospital Charge Code	3008257
Hospital Revenue Code	302
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.94
Rate for Payer: Aetna Medicare Advantage	$39.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.71
Rate for Payer: Cigna Commercial	$33.62
Rate for Payer: Cigna Medicare Advantage	$12.11
Rate for Payer: Clover Medicare Advantage	$11.50
Rate for Payer: EmblemHealth Commercial	$36.33
Rate for Payer: Humana Medicare Advantage	$12.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.18
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.09
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.11
Rate for Payer: Wellcare Medicare Advantage	$12.11
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

Sulfacetamide 10% opht soln 15

Facility

$351.97

Hospital Charge Code	6063943294
Hospital Revenue Code	250
Min. Negotiated Rate	$8.48
Max. Negotiated Rate	$175.99
Rate for Payer: Aetna Commercial	$133.75
Rate for Payer: Aetna Medicare Advantage	$105.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.75
Rate for Payer: Cigna Commercial	$175.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.59
Rate for Payer: Oxford Commercial	$70.39
Rate for Payer: Qualcare PPO/HMO/WC	$52.80
Rate for Payer: UnitedHealthcare Commercial	$70.39
Rate for Payer: UnitedHealthcare Community & State	$8.48
Rate for Payer: Wellpoint Medicaid Managed Care	$9.33

Sulfacetamide 10% opht soln 15

Facility

$351.97

Hospital Charge Code	6063943294
Hospital Revenue Code	250
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$52.80
Rate for Payer: Qualcare PPO/HMO/WC	$52.80

SULFACETAMIDE PREDNIS SOL OPH

Facility

$24.85

Hospital Charge Code	60628715
Hospital Revenue Code	250
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$3.73
Rate for Payer: Qualcare PPO/HMO/WC	$3.73

SULFACETAMIDE PREDNIS SOL OPH

Facility

$24.85

Hospital Charge Code	60628715
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$12.43
Rate for Payer: Aetna Commercial	$9.44
Rate for Payer: Aetna Medicare Advantage	$7.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.34
Rate for Payer: Cigna Commercial	$12.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.46
Rate for Payer: Oxford Commercial	$4.97
Rate for Payer: Qualcare PPO/HMO/WC	$3.73
Rate for Payer: UnitedHealthcare Commercial	$4.97
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

SULFACETAMIDE PREDNIS SSP OPH

Facility

$164.00

Hospital Charge Code	60628029
Hospital Revenue Code	250
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$24.60
Rate for Payer: Qualcare PPO/HMO/WC	$24.60

SULFACETAMIDE PREDNIS SSP OPH

Facility

$164.00

Hospital Charge Code	60628029
Hospital Revenue Code	250
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$82.00
Rate for Payer: Aetna Commercial	$62.32
Rate for Payer: Aetna Medicare Advantage	$49.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.82
Rate for Payer: Cigna Commercial	$82.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.20
Rate for Payer: Oxford Commercial	$32.80
Rate for Payer: Qualcare PPO/HMO/WC	$24.60
Rate for Payer: UnitedHealthcare Commercial	$32.80
Rate for Payer: UnitedHealthcare Community & State	$3.95
Rate for Payer: Wellpoint Medicaid Managed Care	$4.35

SULFACETAMIDE PREDNIS SSP OPH

Facility

$274.45

Hospital Charge Code	60628030
Hospital Revenue Code	250
Min. Negotiated Rate	$41.17
Max. Negotiated Rate	$41.17
Rate for Payer: Qualcare PPO/HMO/WC	$41.17

SULFACETAMIDE PREDNIS SSP OPH

Facility

$274.45

Hospital Charge Code	60628030
Hospital Revenue Code	250
Min. Negotiated Rate	$6.61
Max. Negotiated Rate	$137.22
Rate for Payer: Aetna Commercial	$104.29
Rate for Payer: Aetna Medicare Advantage	$82.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.98
Rate for Payer: Cigna Commercial	$137.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.33
Rate for Payer: Oxford Commercial	$54.89
Rate for Payer: Qualcare PPO/HMO/WC	$41.17
Rate for Payer: UnitedHealthcare Commercial	$54.89
Rate for Payer: UnitedHealthcare Community & State	$6.61
Rate for Payer: Wellpoint Medicaid Managed Care	$7.27

SULFACETAMIDE SD ONTOPH10%3.5G

Facility

$101.80

Hospital Charge Code	6005102
Hospital Revenue Code	251
Min. Negotiated Rate	$15.27
Max. Negotiated Rate	$15.27
Rate for Payer: Qualcare PPO/HMO/WC	$15.27

SULFACETAMIDE SD ONTOPH10%3.5G

Facility

$101.80

Hospital Charge Code	6005102
Hospital Revenue Code	251
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$50.90
Rate for Payer: Aetna Commercial	$38.68
Rate for Payer: Aetna Medicare Advantage	$30.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.96
Rate for Payer: Cigna Commercial	$50.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.54
Rate for Payer: Oxford Commercial	$20.36
Rate for Payer: Qualcare PPO/HMO/WC	$15.27
Rate for Payer: UnitedHealthcare Commercial	$20.36
Rate for Payer: UnitedHealthcare Community & State	$2.45
Rate for Payer: Wellpoint Medicaid Managed Care	$2.70

SULFACETAMIDE SD OPH 10% 1ML

Facility

$34.60

Hospital Charge Code	6005110
Hospital Revenue Code	251
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$13.15
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.38
Rate for Payer: Oxford Commercial	$6.92
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$6.92
Rate for Payer: UnitedHealthcare Community & State	$0.83
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

SULFACETAMIDE SD OPH 10% 1ML

Facility

$34.60

Hospital Charge Code	6005110
Hospital Revenue Code	251
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

SULFACETAMIDE SODIUM 10%

Facility

$6.00

Hospital Charge Code	60633925
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

SULFACETAMIDE SODIUM 10%

Facility

$5.00

Hospital Charge Code	60633926
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

SULFACETAMIDE SODIUM 10%

Facility

$5.00

Hospital Charge Code	60633926
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

SULFACETAMIDE SODIUM 10%

Facility

$6.00

Hospital Charge Code	60633925
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

SULFACE TAM-PRED OPH OIN 3.5GR

Facility

$772.78

Service Code	NDC 23031304
Hospital Charge Code	60628802
Hospital Revenue Code	250
Min. Negotiated Rate	$115.92
Max. Negotiated Rate	$115.92
Rate for Payer: Qualcare PPO/HMO/WC	$115.92

SULFACE TAM-PRED OPH OIN 3.5GR

Facility

$772.78

Service Code	NDC 23031304
Hospital Charge Code	60628802
Hospital Revenue Code	250
Min. Negotiated Rate	$18.62
Max. Negotiated Rate	$386.39
Rate for Payer: Aetna Commercial	$293.66
Rate for Payer: Aetna Medicare Advantage	$231.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.06
Rate for Payer: Cigna Commercial	$386.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.83
Rate for Payer: Oxford Commercial	$154.56
Rate for Payer: Qualcare PPO/HMO/WC	$115.92
Rate for Payer: UnitedHealthcare Commercial	$154.56
Rate for Payer: UnitedHealthcare Community & State	$18.62
Rate for Payer: Wellpoint Medicaid Managed Care	$20.48

SULFACETM SD OPTH 10% 5ML

Facility

$101.80

Hospital Charge Code	6005128
Hospital Revenue Code	251
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$50.90
Rate for Payer: Aetna Commercial	$38.68
Rate for Payer: Aetna Medicare Advantage	$30.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.96
Rate for Payer: Cigna Commercial	$50.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.54
Rate for Payer: Oxford Commercial	$20.36
Rate for Payer: Qualcare PPO/HMO/WC	$15.27
Rate for Payer: UnitedHealthcare Commercial	$20.36
Rate for Payer: UnitedHealthcare Community & State	$2.45
Rate for Payer: Wellpoint Medicaid Managed Care	$2.70

SULFACETM SD OPTH 10% 5ML

Facility

$101.80

Hospital Charge Code	6005128
Hospital Revenue Code	251
Min. Negotiated Rate	$15.27
Max. Negotiated Rate	$15.27
Rate for Payer: Qualcare PPO/HMO/WC	$15.27

SULFADIAZINE/500MG

Facility

$3.00

Hospital Charge Code	60634750
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SULFADIAZINE/500MG

Facility

$3.00

Hospital Charge Code	60634750
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

SULFADIAZINE 500 MG TAB

Facility

$33.84

Service Code	NDC 185075701
Hospital Charge Code	60629052
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$16.92
Rate for Payer: Aetna Commercial	$12.86
Rate for Payer: Aetna Medicare Advantage	$10.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.63
Rate for Payer: Cigna Commercial	$16.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.15
Rate for Payer: Oxford Commercial	$6.77
Rate for Payer: Qualcare PPO/HMO/WC	$5.08
Rate for Payer: UnitedHealthcare Commercial	$6.77
Rate for Payer: UnitedHealthcare Community & State	$0.82
Rate for Payer: Wellpoint Medicaid Managed Care	$0.90

Know your out-of-pocket cost for care.

All Charges