Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SYMMETREL LIQUID/16OZ

Facility

$4.00

Service Code	NDC 121064616
Hospital Charge Code	60634589
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

SYMMETREL LIQUID/16OZ

Facility

$4.00

Service Code	NDC 121064616
Hospital Charge Code	60634589
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SYMPHONY GRAFT DELIVERY SYS

Facility

$1,050.00

Hospital Charge Code	270657922
Hospital Revenue Code	272
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$157.50
Rate for Payer: Qualcare PPO/HMO/WC	$157.50

SYMPHONY GRAFT DELIVERY SYS

Facility

$1,050.00

Hospital Charge Code	270657922
Hospital Revenue Code	272
Min. Negotiated Rate	$25.30
Max. Negotiated Rate	$525.00
Rate for Payer: Aetna Commercial	$399.00
Rate for Payer: Aetna Medicare Advantage	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.75
Rate for Payer: Cigna Commercial	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$315.00
Rate for Payer: Oxford Commercial	$210.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.50
Rate for Payer: UnitedHealthcare Commercial	$210.00
Rate for Payer: UnitedHealthcare Community & State	$25.30
Rate for Payer: Wellpoint Medicaid Managed Care	$27.82

SYNALAR 0.1% CREAM/15GM

Facility

$298.62

Service Code	NDC 168005815
Hospital Charge Code	60634441
Hospital Revenue Code	250
Min. Negotiated Rate	$44.79
Max. Negotiated Rate	$44.79
Rate for Payer: Qualcare PPO/HMO/WC	$44.79

SYNALAR 0.1% CREAM/15GM

Facility

$298.62

Service Code	NDC 168005815
Hospital Charge Code	60634441
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$149.31
Rate for Payer: Aetna Commercial	$113.48
Rate for Payer: Aetna Medicare Advantage	$89.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.15
Rate for Payer: Cigna Commercial	$149.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.59
Rate for Payer: Oxford Commercial	$59.72
Rate for Payer: Qualcare PPO/HMO/WC	$44.79
Rate for Payer: UnitedHealthcare Commercial	$59.72
Rate for Payer: UnitedHealthcare Community & State	$7.20
Rate for Payer: Wellpoint Medicaid Managed Care	$7.91

SYNALAR .025% CREAM/15GM

Facility

$71.00

Hospital Charge Code	60634442
Hospital Revenue Code	250
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

SYNALAR .025% CREAM/15GM

Facility

$71.00

Hospital Charge Code	60634442
Hospital Revenue Code	250
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$35.50
Rate for Payer: Aetna Commercial	$26.98
Rate for Payer: Aetna Medicare Advantage	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.11
Rate for Payer: Cigna Commercial	$35.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.30
Rate for Payer: Oxford Commercial	$14.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Commercial	$14.20
Rate for Payer: UnitedHealthcare Community & State	$1.71
Rate for Payer: Wellpoint Medicaid Managed Care	$1.88

SYNALAR OINTMENT/15GM

Facility

$226.26

Service Code	NDC 168006415
Hospital Charge Code	60634443
Hospital Revenue Code	250
Min. Negotiated Rate	$33.94
Max. Negotiated Rate	$33.94
Rate for Payer: Qualcare PPO/HMO/WC	$33.94

SYNALAR OINTMENT/15GM

Facility

$226.26

Service Code	NDC 168006415
Hospital Charge Code	60634443
Hospital Revenue Code	250
Min. Negotiated Rate	$5.45
Max. Negotiated Rate	$113.13
Rate for Payer: Aetna Commercial	$85.98
Rate for Payer: Aetna Medicare Advantage	$67.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.70
Rate for Payer: Cigna Commercial	$113.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.88
Rate for Payer: Oxford Commercial	$45.25
Rate for Payer: Qualcare PPO/HMO/WC	$33.94
Rate for Payer: UnitedHealthcare Commercial	$45.25
Rate for Payer: UnitedHealthcare Community & State	$5.45
Rate for Payer: Wellpoint Medicaid Managed Care	$6.00

SYNCHFIX EVT SYNDESMOSIS #5 SU

Facility

$13,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270705891
Hospital Revenue Code	278
Min. Negotiated Rate	$331.38
Max. Negotiated Rate	$6,875.00
Rate for Payer: Aetna Commercial	$5,225.00
Rate for Payer: Aetna Medicare Advantage	$4,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,506.25
Rate for Payer: Cigna Commercial	$6,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50
Rate for Payer: UnitedHealthcare Community & State	$331.38
Rate for Payer: Wellpoint Medicaid Managed Care	$364.38

SYNCHFIX EVT SYNDESMOSIS #5 SU

Facility

$13,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270705891
Hospital Revenue Code	278
Min. Negotiated Rate	$2,062.50
Max. Negotiated Rate	$3,327.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50

Synchro 200cm soft

Facility

$3,000.00

Hospital Charge Code	270685069N
Hospital Revenue Code	272
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$450.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

Synchro 200cm soft

Facility

$3,000.00

Hospital Charge Code	270685069N
Hospital Revenue Code	272
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$900.00
Rate for Payer: Oxford Commercial	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Commercial	$600.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

Synchro 300cm soft

Facility

$3,750.00

Hospital Charge Code	270685070N
Hospital Revenue Code	272
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,125.00
Rate for Payer: Oxford Commercial	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Commercial	$750.00
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

Synchro 300cm soft

Facility

$3,750.00

Hospital Charge Code	270685070N
Hospital Revenue Code	272
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$562.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

Synchro 300cm Stand

Facility

$3,750.00

Hospital Charge Code	270685071N
Hospital Revenue Code	272
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$562.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

Synchro 300cm Stand

Facility

$3,750.00

Hospital Charge Code	270685071N
Hospital Revenue Code	272
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,125.00
Rate for Payer: Oxford Commercial	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Commercial	$750.00
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

SYNCHROSEAL 8MM

Facility

$3,450.00

Service Code	HCPCS A4649
Hospital Charge Code	270693939
Hospital Revenue Code	272
Min. Negotiated Rate	$517.50
Max. Negotiated Rate	$517.50
Rate for Payer: Qualcare PPO/HMO/WC	$517.50

SYNCHROSEAL 8MM

Facility

$3,450.00

Service Code	HCPCS A4649
Hospital Charge Code	270693939
Hospital Revenue Code	272
Min. Negotiated Rate	$83.14
Max. Negotiated Rate	$1,725.00
Rate for Payer: Aetna Commercial	$1,311.00
Rate for Payer: Aetna Medicare Advantage	$1,035.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$879.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$879.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$879.75
Rate for Payer: Cigna Commercial	$1,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,035.00
Rate for Payer: Oxford Commercial	$690.00
Rate for Payer: Qualcare PPO/HMO/WC	$517.50
Rate for Payer: UnitedHealthcare Commercial	$690.00
Rate for Payer: UnitedHealthcare Community & State	$83.14
Rate for Payer: Wellpoint Medicaid Managed Care	$91.42

SYNCOPE AND COLLAPSE

Facility

$10,341.33

Service Code	APR-DRG 2043
Min. Negotiated Rate	$10,138.56
Max. Negotiated Rate	$10,341.33
Rate for Payer: UnitedHealthcare Community & State	$10,138.56
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,341.33
Rate for Payer: Wellpoint Medicaid Managed Care	$10,138.56

SYNCOPE AND COLLAPSE

Facility

$8,073.93

Service Code	APR-DRG 2042
Min. Negotiated Rate	$7,915.62
Max. Negotiated Rate	$8,073.93
Rate for Payer: UnitedHealthcare Community & State	$7,915.62
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,073.93
Rate for Payer: Wellpoint Medicaid Managed Care	$7,915.62

SYNCOPE AND COLLAPSE

Facility

$30,305.65

Service Code	MSDRG 312
Min. Negotiated Rate	$9,227.68
Max. Negotiated Rate	$30,305.65
Rate for Payer: Aetna Commercial	$21,080.76
Rate for Payer: Aetna Medicare Advantage	$30,305.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20,004.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20,004.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9,713.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20,004.46
Rate for Payer: Cigna Commercial	$16,311.12
Rate for Payer: Cigna Medicare Advantage	$9,713.35
Rate for Payer: Clover Medicare Advantage	$9,227.68
Rate for Payer: EmblemHealth Commercial	$29,140.05
Rate for Payer: Humana Medicare Advantage	$10,004.75
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9,713.35
Rate for Payer: Oxford Commercial	$11,723.02
Rate for Payer: UnitedHealthcare Commercial	$20,556.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$9,713.35
Rate for Payer: Wellcare Medicare Advantage	$9,713.35

SYNCOPE AND COLLAPSE

Facility

$6,845.74

Service Code	APR-DRG 2041
Min. Negotiated Rate	$6,711.51
Max. Negotiated Rate	$6,845.74
Rate for Payer: UnitedHealthcare Community & State	$6,711.51
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,845.74
Rate for Payer: Wellpoint Medicaid Managed Care	$6,711.51

SYNCOPE AND COLLAPSE

Facility

$17,146.24

Service Code	APR-DRG 2044
Min. Negotiated Rate	$16,810.04
Max. Negotiated Rate	$17,146.24
Rate for Payer: UnitedHealthcare Community & State	$16,810.04
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$17,146.24
Rate for Payer: Wellpoint Medicaid Managed Care	$16,810.04

Know your out-of-pocket cost for care.

All Charges