Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SULFONAMIDES UNDIFF SERUM/PLSM

Facility

$390.00

Service Code	HCPCS 80299
Hospital Charge Code	401180299
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
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	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

SULFONYLUREA

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38472607
Hospital Revenue Code	301
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

SULFONYLUREA

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38472607
Hospital Revenue Code	301
Min. Negotiated Rate	$8.59
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$8.59

SULFONYLUREA SCREEN QT, UR

Facility

$181.65

Service Code	HCPCS 82542
Hospital Charge Code	3038114
Hospital Revenue Code	300
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$65.52
Rate for Payer: Aetna Medicare Advantage	$78.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.96
Rate for Payer: Cigna Commercial	$90.83
Rate for Payer: Cigna Medicare Advantage	$24.09
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Medicare Advantage	$24.09
Rate for Payer: Wellpoint Medicaid Managed Care	$4.81

SULFONYLUREA SCREEN QT, UR

Facility

$181.65

Service Code	HCPCS 82542
Hospital Charge Code	3038114
Hospital Revenue Code	300
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

SULFUR-SALICYLIC SHAMPOO

Facility

$67.25

Hospital Charge Code	60628436
Hospital Revenue Code	250
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$10.09
Rate for Payer: Qualcare PPO/HMO/WC	$10.09

SULFUR-SALICYLIC SHAMPOO

Facility

$67.25

Hospital Charge Code	60628436
Hospital Revenue Code	250
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$33.62
Rate for Payer: Aetna Commercial	$25.55
Rate for Payer: Aetna Medicare Advantage	$20.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.15
Rate for Payer: Cigna Commercial	$33.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.18
Rate for Payer: Oxford Commercial	$13.45
Rate for Payer: Qualcare PPO/HMO/WC	$10.09
Rate for Payer: UnitedHealthcare Commercial	$13.45
Rate for Payer: UnitedHealthcare Community & State	$1.62
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

SULINDAC 150 MG TAB

Facility

$9.65

Hospital Charge Code	60627697
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.90
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$1.93
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

SULINDAC 150 MG TAB

Facility

$9.65

Hospital Charge Code	60627697
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

SULINDAC 200 MG TAB

Facility

$11.25

Hospital Charge Code	60627698
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.38
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

SULINDAC 200 MG TAB

Facility

$11.25

Hospital Charge Code	60627698
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

SUMATRIPTAN 25 MG TAB

Facility

$222.78

Service Code	NDC 173073500
Hospital Charge Code	60629927
Hospital Revenue Code	250
Min. Negotiated Rate	$5.37
Max. Negotiated Rate	$111.39
Rate for Payer: Aetna Commercial	$84.66
Rate for Payer: Aetna Medicare Advantage	$66.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.81
Rate for Payer: Cigna Commercial	$111.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.83
Rate for Payer: Oxford Commercial	$44.56
Rate for Payer: Qualcare PPO/HMO/WC	$33.42
Rate for Payer: UnitedHealthcare Commercial	$44.56
Rate for Payer: UnitedHealthcare Community & State	$5.37
Rate for Payer: Wellpoint Medicaid Managed Care	$5.90

SUMATRIPTAN 25 MG TAB

Facility

$222.78

Service Code	NDC 173073500
Hospital Charge Code	60629927
Hospital Revenue Code	250
Min. Negotiated Rate	$33.42
Max. Negotiated Rate	$33.42
Rate for Payer: Qualcare PPO/HMO/WC	$33.42

SUMATRIPTAN 6 MG/0.5 ML INJ

Facility

$569.50

Service Code	HCPCS J3030
Hospital Charge Code	6007728
Hospital Revenue Code	636
Min. Negotiated Rate	$85.42
Max. Negotiated Rate	$137.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.82
Rate for Payer: Qualcare PPO/HMO/WC	$85.42

SUMATRIPTAN 6 MG/0.5 ML INJ

Facility

$569.50

Service Code	HCPCS J3030
Hospital Charge Code	6007728
Hospital Revenue Code	636
Min. Negotiated Rate	$13.72
Max. Negotiated Rate	$284.75
Rate for Payer: Aetna Commercial	$216.41
Rate for Payer: Aetna Medicare Advantage	$170.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$145.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$145.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$145.22
Rate for Payer: Cigna Commercial	$284.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.82
Rate for Payer: Qualcare PPO/HMO/WC	$85.42
Rate for Payer: UnitedHealthcare Community & State	$13.72
Rate for Payer: Wellpoint Medicaid Managed Care	$15.09

SUMP PUMP ************

Facility

$153.00

Hospital Charge Code	8001695
Hospital Revenue Code	279
Min. Negotiated Rate	$3.69
Max. Negotiated Rate	$76.50
Rate for Payer: Aetna Commercial	$58.14
Rate for Payer: Aetna Medicare Advantage	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.02
Rate for Payer: Cigna Commercial	$76.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.90
Rate for Payer: Oxford Commercial	$30.60
Rate for Payer: Qualcare PPO/HMO/WC	$22.95
Rate for Payer: UnitedHealthcare Commercial	$30.60
Rate for Payer: UnitedHealthcare Community & State	$3.69
Rate for Payer: Wellpoint Medicaid Managed Care	$4.05

SUMP PUMP ************

Facility

$153.00

Hospital Charge Code	8001695
Hospital Revenue Code	279
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$22.95
Rate for Payer: Qualcare PPO/HMO/WC	$22.95

SUMP PUMP DISP AN-42

Facility

$417.15

Hospital Charge Code	270650475
Hospital Revenue Code	272
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$208.57
Rate for Payer: Aetna Commercial	$158.52
Rate for Payer: Aetna Medicare Advantage	$125.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$106.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$106.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$106.37
Rate for Payer: Cigna Commercial	$208.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.14
Rate for Payer: Oxford Commercial	$83.43
Rate for Payer: Qualcare PPO/HMO/WC	$62.57
Rate for Payer: UnitedHealthcare Commercial	$83.43
Rate for Payer: UnitedHealthcare Community & State	$10.05
Rate for Payer: Wellpoint Medicaid Managed Care	$11.05

SUMP PUMP DISP AN-42

Facility

$417.15

Hospital Charge Code	270650475
Hospital Revenue Code	272
Min. Negotiated Rate	$62.57
Max. Negotiated Rate	$62.57
Rate for Payer: Qualcare PPO/HMO/WC	$62.57

SUMYCIN/125MG/5ML

Facility

$23.00

Hospital Charge Code	60633933
Hospital Revenue Code	250
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

SUMYCIN/125MG/5ML

Facility

$23.00

Hospital Charge Code	60633933
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$8.74
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.90
Rate for Payer: Oxford Commercial	$4.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$4.60
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

SUMYCIN 250/250MG/CAP

Facility

$3.00

Hospital Charge Code	60633935
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SUMYCIN 250/250MG/CAP

Facility

$3.00

Hospital Charge Code	60633934
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SUMYCIN 250/250MG/CAP

Facility

$3.00

Hospital Charge Code	60633934
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

SUMYCIN 250/250MG/CAP

Facility

$3.00

Hospital Charge Code	60633935
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

Know your out-of-pocket cost for care.

All Charges