Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SULFANILAMIDE CRM VAG 15%

Facility

$312.00

Hospital Charge Code	60628331
Hospital Revenue Code	250
Min. Negotiated Rate	$7.52
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$118.56
Rate for Payer: Aetna Medicare Advantage	$93.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.56
Rate for Payer: Cigna Commercial	$156.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.60
Rate for Payer: Oxford Commercial	$62.40
Rate for Payer: Qualcare PPO/HMO/WC	$46.80
Rate for Payer: UnitedHealthcare Commercial	$62.40
Rate for Payer: UnitedHealthcare Community & State	$7.52
Rate for Payer: Wellpoint Medicaid Managed Care	$8.27

SULFANILAMIDE CRM VAG 15%

Facility

$312.00

Hospital Charge Code	60628331
Hospital Revenue Code	250
Min. Negotiated Rate	$46.80
Max. Negotiated Rate	$46.80
Rate for Payer: Qualcare PPO/HMO/WC	$46.80

SULFASALAZINE 500 MG TAB

Facility

$4.00

Service Code	NDC 603580121
Hospital Charge Code	60628716
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SULFASALAZINE 500 MG TAB

Facility

$4.00

Service Code	NDC 603580121
Hospital Charge Code	60628716
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

SULFASALAZINE/500MG/TAB

Facility

$3.00

Hospital Charge Code	60633932
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

SULFASALAZINE/500MG/TAB

Facility

$3.00

Hospital Charge Code	60633932
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SULFASALAZINE/500MG/TAB

Facility

$3.00

Hospital Charge Code	60633930
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SULFASALAZINE/500MG/TAB

Facility

$3.00

Hospital Charge Code	60633930
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

SULFASALAZINE/500MG/TAB

Facility

$3.00

Hospital Charge Code	60633931
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SULFASALAZINE/500MG/TAB

Facility

$3.00

Hospital Charge Code	60633931
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

SULFATED GPG - SGPG

Facility

$111.00

Hospital Charge Code	3031598E
Hospital Revenue Code	301
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$42.18
Rate for Payer: Aetna Medicare Advantage	$33.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.30
Rate for Payer: Cigna Commercial	$55.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.68
Rate for Payer: Wellpoint Medicaid Managed Care	$2.94

SULFATED GPG - SGPG

Facility

$111.00

Hospital Charge Code	3031598E
Hospital Revenue Code	301
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.65

SULFATE URINE

Facility

$390.00

Service Code	HCPCS 84392
Hospital Charge Code	39990241K
Hospital Revenue Code	301
Min. Negotiated Rate	$4.39
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.93
Rate for Payer: Aetna Medicare Advantage	$17.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.82
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.49
Rate for Payer: Clover Medicare Advantage	$5.22
Rate for Payer: EmblemHealth Commercial	$16.47
Rate for Payer: Humana Medicare Advantage	$5.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.49
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	$4.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.49
Rate for Payer: Wellcare Medicare Advantage	$5.49
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

SULFATE URINE

Facility

$390.00

Service Code	HCPCS 84392
Hospital Charge Code	39990241K
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SULFATE, URINE

Facility

$33.65

Service Code	HCPCS 84392
Hospital Charge Code	38477036
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$5.05
Rate for Payer: Qualcare PPO/HMO/WC	$5.05

SULFATE, URINE

Facility

$33.65

Service Code	HCPCS 84392
Hospital Charge Code	38477036
Hospital Revenue Code	301
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.93
Rate for Payer: Aetna Medicare Advantage	$17.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.82
Rate for Payer: Cigna Commercial	$16.82
Rate for Payer: Cigna Medicare Advantage	$5.49
Rate for Payer: Clover Medicare Advantage	$5.22
Rate for Payer: EmblemHealth Commercial	$16.47
Rate for Payer: Humana Medicare Advantage	$5.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.49
Rate for Payer: Wellcare Medicare Advantage	$5.49
Rate for Payer: Wellpoint Medicaid Managed Care	$0.89

SULFATIDE AUTO ANTIBODY

Facility

$253.45

Service Code	HCPCS 83520
Hospital Charge Code	3001070
Hospital Revenue Code	301
Min. Negotiated Rate	$38.02
Max. Negotiated Rate	$38.02
Rate for Payer: Qualcare PPO/HMO/WC	$38.02

SULFATIDE AUTO ANTIBODY

Facility

$253.45

Service Code	HCPCS 83520
Hospital Charge Code	3001070
Hospital Revenue Code	301
Min. Negotiated Rate	$6.72
Max. Negotiated Rate	$126.72
Rate for Payer: Aetna Commercial	$46.97
Rate for Payer: Aetna Medicare Advantage	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.34
Rate for Payer: Cigna Commercial	$126.72
Rate for Payer: Cigna Medicare Advantage	$17.27
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.03
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.02
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Medicare Advantage	$17.27
Rate for Payer: Wellpoint Medicaid Managed Care	$6.72

SULFA TRIPLE 1MG

Facility

$61.63

Hospital Charge Code	270669738
Hospital Revenue Code	272
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$9.24
Rate for Payer: Qualcare PPO/HMO/WC	$9.24

SULFA TRIPLE 1MG

Facility

$61.63

Hospital Charge Code	270669738
Hospital Revenue Code	272
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$30.82
Rate for Payer: Aetna Commercial	$23.42
Rate for Payer: Aetna Medicare Advantage	$18.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.72
Rate for Payer: Cigna Commercial	$30.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.49
Rate for Payer: Oxford Commercial	$12.33
Rate for Payer: Qualcare PPO/HMO/WC	$9.24
Rate for Payer: UnitedHealthcare Commercial	$12.33
Rate for Payer: UnitedHealthcare Community & State	$1.49
Rate for Payer: Wellpoint Medicaid Managed Care	$1.63

SULFISOXASOLE OPH DROP

Facility

$86.40

Hospital Charge Code	6007348
Hospital Revenue Code	252
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna Commercial	$32.83
Rate for Payer: Aetna Medicare Advantage	$25.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.03
Rate for Payer: Cigna Commercial	$43.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.92
Rate for Payer: Oxford Commercial	$17.28
Rate for Payer: Qualcare PPO/HMO/WC	$12.96
Rate for Payer: UnitedHealthcare Commercial	$17.28
Rate for Payer: UnitedHealthcare Community & State	$2.08
Rate for Payer: Wellpoint Medicaid Managed Care	$2.29

SULFISOXASOLE OPH DROP

Facility

$86.40

Hospital Charge Code	6007348
Hospital Revenue Code	252
Min. Negotiated Rate	$12.96
Max. Negotiated Rate	$12.96
Rate for Payer: Qualcare PPO/HMO/WC	$12.96

SULFISOXAZOLE 500 MG TAB

Facility

$4.00

Hospital Charge Code	60627350
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SULFISOXAZOLE 500 MG TAB

Facility

$4.00

Hospital Charge Code	60627350
Hospital Revenue Code	251
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

SULFONAMIDES UNDIFF SERUM/PLSM

Facility

$390.00

Service Code	HCPCS 80299
Hospital Charge Code	401180299
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges