Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SUMYCIN 500/500MG/CAP

Facility

$3.00

Hospital Charge Code	60633936
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 500/500MG/CAP

Facility

$3.00

Hospital Charge Code	60633936
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SUMYCIN 500/500MG/CAP

Facility

$3.00

Hospital Charge Code	60633937
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 500/500MG/CAP

Facility

$3.00

Hospital Charge Code	60633937
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SUMYCIN 500/500MG/TAB

Facility

$3.00

Hospital Charge Code	60633938
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SUMYCIN 500/500MG/TAB

Facility

$3.00

Hospital Charge Code	60633938
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

SUPERCORE BX INSTRMT 14G 15cm

Facility

$180.00

Hospital Charge Code	270645786
Hospital Revenue Code	271
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna Commercial	$68.40
Rate for Payer: Aetna Medicare Advantage	$54.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.90
Rate for Payer: Cigna Commercial	$90.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.00
Rate for Payer: Oxford Commercial	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00
Rate for Payer: UnitedHealthcare Commercial	$36.00
Rate for Payer: UnitedHealthcare Community & State	$4.34
Rate for Payer: Wellpoint Medicaid Managed Care	$4.77

SUPERCORE BX INSTRMT 14G 15cm

Facility

$180.00

Hospital Charge Code	270645786
Hospital Revenue Code	271
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00

SUPERF SFT TISS BX LEG/ANKLE

Facility

$7,612.30

Service Code	HCPCS 27613
Hospital Charge Code	16000709
Hospital Revenue Code	360
Min. Negotiated Rate	$183.46
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,283.69
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,141.85
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$183.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$201.73

SUPERF SFT TISS BX LEG/ANKLE

Facility

$7,612.30

Service Code	HCPCS 27613
Hospital Charge Code	16000709
Hospital Revenue Code	360
Min. Negotiated Rate	$1,141.85
Max. Negotiated Rate	$1,141.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,141.85

SUPERSHEATH INTRO WO GWIRE 12F

Facility

$102.90

Service Code	HCPCS C1894
Hospital Charge Code	270662366C
Hospital Revenue Code	272
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$51.45
Rate for Payer: Aetna Commercial	$39.10
Rate for Payer: Aetna Medicare Advantage	$30.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.24
Rate for Payer: Cigna Commercial	$51.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.87
Rate for Payer: Oxford Commercial	$20.58
Rate for Payer: Qualcare PPO/HMO/WC	$15.44
Rate for Payer: UnitedHealthcare Commercial	$20.58
Rate for Payer: UnitedHealthcare Community & State	$2.48
Rate for Payer: Wellpoint Medicaid Managed Care	$2.73

SUPERSHEATH INTRO WO GWIRE 12F

Facility

$102.90

Service Code	HCPCS C1894
Hospital Charge Code	270662366C
Hospital Revenue Code	272
Min. Negotiated Rate	$15.44
Max. Negotiated Rate	$15.44
Rate for Payer: Qualcare PPO/HMO/WC	$15.44

SUPER TURBOVAC W FINGER SWITCH

Facility

$2,185.00

Hospital Charge Code	270652890
Hospital Revenue Code	272
Min. Negotiated Rate	$52.66
Max. Negotiated Rate	$1,092.50
Rate for Payer: Aetna Commercial	$830.30
Rate for Payer: Aetna Medicare Advantage	$655.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$557.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$557.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$557.17
Rate for Payer: Cigna Commercial	$1,092.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$655.50
Rate for Payer: Oxford Commercial	$437.00
Rate for Payer: Qualcare PPO/HMO/WC	$327.75
Rate for Payer: UnitedHealthcare Commercial	$437.00
Rate for Payer: UnitedHealthcare Community & State	$52.66
Rate for Payer: Wellpoint Medicaid Managed Care	$57.90

SUPER TURBOVAC W FINGER SWITCH

Facility

$2,185.00

Hospital Charge Code	270652890
Hospital Revenue Code	272
Min. Negotiated Rate	$327.75
Max. Negotiated Rate	$327.75
Rate for Payer: Qualcare PPO/HMO/WC	$327.75

SUPPORTA-LINE STANDARD

Facility

$13.33

Hospital Charge Code	270667643
Hospital Revenue Code	270
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.00

SUPPORTA-LINE STANDARD

Facility

$13.33

Hospital Charge Code	270667643
Hospital Revenue Code	270
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$6.67
Rate for Payer: Aetna Commercial	$5.07
Rate for Payer: Aetna Medicare Advantage	$4.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.40
Rate for Payer: Cigna Commercial	$6.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.00
Rate for Payer: Oxford Commercial	$2.67
Rate for Payer: Qualcare PPO/HMO/WC	$2.00
Rate for Payer: UnitedHealthcare Commercial	$2.67
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.35

SUPPORT ALM DLX ARTERIO 95985

Facility

$30.45

Hospital Charge Code	270617244
Hospital Revenue Code	272
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$15.22
Rate for Payer: Aetna Commercial	$11.57
Rate for Payer: Aetna Medicare Advantage	$9.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.76
Rate for Payer: Cigna Commercial	$15.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.13
Rate for Payer: Oxford Commercial	$6.09
Rate for Payer: Qualcare PPO/HMO/WC	$4.57
Rate for Payer: UnitedHealthcare Commercial	$6.09
Rate for Payer: UnitedHealthcare Community & State	$0.73
Rate for Payer: Wellpoint Medicaid Managed Care	$0.81

SUPPORT ALM DLX ARTERIO 95985

Facility

$30.45

Hospital Charge Code	270617244
Hospital Revenue Code	272
Min. Negotiated Rate	$4.57
Max. Negotiated Rate	$4.57
Rate for Payer: Qualcare PPO/HMO/WC	$4.57

SUPPORT CATH 5F .035X135CM

Facility

$775.00

Service Code	HCPCS C1887
Hospital Charge Code	270670063
Hospital Revenue Code	278
Min. Negotiated Rate	$18.68
Max. Negotiated Rate	$387.50
Rate for Payer: Aetna Commercial	$294.50
Rate for Payer: Aetna Medicare Advantage	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.62
Rate for Payer: Cigna Commercial	$387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$170.50
Rate for Payer: Qualcare PPO/HMO/WC	$116.25
Rate for Payer: UnitedHealthcare Community & State	$18.68
Rate for Payer: Wellpoint Medicaid Managed Care	$20.54

SUPPORT CATH 5F .035X135CM

Facility

$775.00

Service Code	HCPCS C1887
Hospital Charge Code	270670063
Hospital Revenue Code	278
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$187.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$170.50
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

SUPPORTER ******

Facility

$24.00

Hospital Charge Code	8001638
Hospital Revenue Code	279
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna Commercial	$9.12
Rate for Payer: Aetna Medicare Advantage	$7.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.12
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.20
Rate for Payer: Oxford Commercial	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$3.60
Rate for Payer: UnitedHealthcare Commercial	$4.80
Rate for Payer: UnitedHealthcare Community & State	$0.58
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

SUPPORTER ******

Facility

$24.00

Hospital Charge Code	8001638
Hospital Revenue Code	279
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.60

SUPPORTER ADULT ELASTIC SML

Facility

$42.35

Hospital Charge Code	270649799
Hospital Revenue Code	272
Min. Negotiated Rate	$6.35
Max. Negotiated Rate	$6.35
Rate for Payer: Qualcare PPO/HMO/WC	$6.35

SUPPORTER ADULT ELASTIC SML

Facility

$42.35

Hospital Charge Code	270649799
Hospital Revenue Code	272
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$21.18
Rate for Payer: Aetna Commercial	$16.09
Rate for Payer: Aetna Medicare Advantage	$12.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.80
Rate for Payer: Cigna Commercial	$21.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.71
Rate for Payer: Oxford Commercial	$8.47
Rate for Payer: Qualcare PPO/HMO/WC	$6.35
Rate for Payer: UnitedHealthcare Commercial	$8.47
Rate for Payer: UnitedHealthcare Community & State	$1.02
Rate for Payer: Wellpoint Medicaid Managed Care	$1.12

SUPPORT FOOT UNIVERSL 82652000

Facility

$845.00

Hospital Charge Code	270643408
Hospital Revenue Code	272
Min. Negotiated Rate	$20.36
Max. Negotiated Rate	$422.50
Rate for Payer: Aetna Commercial	$321.10
Rate for Payer: Aetna Medicare Advantage	$253.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.47
Rate for Payer: Cigna Commercial	$422.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.50
Rate for Payer: Oxford Commercial	$169.00
Rate for Payer: Qualcare PPO/HMO/WC	$126.75
Rate for Payer: UnitedHealthcare Commercial	$169.00
Rate for Payer: UnitedHealthcare Community & State	$20.36
Rate for Payer: Wellpoint Medicaid Managed Care	$22.39

Know your out-of-pocket cost for care.

All Charges