Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MANNITOL 20% 500ML IN G

Facility

$80.00

Hospital Charge Code	270040091
Hospital Revenue Code	272
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

MANNITOL 20% 500ML IN G

Facility

$80.00

Hospital Charge Code	270040091
Hospital Revenue Code	272
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$30.40
Rate for Payer: Aetna Medicare Advantage	$24.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.40
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.00
Rate for Payer: Oxford Commercial	$16.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Commercial	$16.00
Rate for Payer: UnitedHealthcare Community & State	$1.93
Rate for Payer: Wellpoint Medicaid Managed Care	$2.12

MANNITOL 20% INFUSION 500ML

Facility

$79.40

Hospital Charge Code	6012819
Hospital Revenue Code	250
Min. Negotiated Rate	$11.91
Max. Negotiated Rate	$11.91
Rate for Payer: Qualcare PPO/HMO/WC	$11.91

MANNITOL 20% INFUSION 500ML

Facility

$79.40

Hospital Charge Code	6012819
Hospital Revenue Code	250
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$39.70
Rate for Payer: Aetna Commercial	$30.17
Rate for Payer: Aetna Medicare Advantage	$23.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.25
Rate for Payer: Cigna Commercial	$39.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.82
Rate for Payer: Oxford Commercial	$15.88
Rate for Payer: Qualcare PPO/HMO/WC	$11.91
Rate for Payer: UnitedHealthcare Commercial	$15.88
Rate for Payer: UnitedHealthcare Community & State	$1.91
Rate for Payer: Wellpoint Medicaid Managed Care	$2.10

MANNITOL 25%/12.5GM/50ML

Facility

$15.00

Hospital Charge Code	60633353
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

MANNITOL 25%/12.5GM/50ML

Facility

$15.00

Hospital Charge Code	60633353
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$3.00
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

MANNITOL 5%

Facility

$49.00

Hospital Charge Code	60634497
Hospital Revenue Code	636
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$24.50
Rate for Payer: Aetna Commercial	$18.62
Rate for Payer: Aetna Medicare Advantage	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.49
Rate for Payer: Cigna Commercial	$24.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.86
Rate for Payer: Qualcare PPO/HMO/WC	$7.35
Rate for Payer: UnitedHealthcare Community & State	$1.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.30

MANNITOL 5%

Facility

$49.00

Hospital Charge Code	60634497
Hospital Revenue Code	636
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$11.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.86
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

MANNITOL 500 ML SOL

Facility

$129.24

Service Code	NDC 264757810
Hospital Charge Code	60627971
Hospital Revenue Code	250
Min. Negotiated Rate	$19.39
Max. Negotiated Rate	$19.39
Rate for Payer: Qualcare PPO/HMO/WC	$19.39

MANNITOL 500 ML SOL

Facility

$129.24

Service Code	NDC 264757810
Hospital Charge Code	60627971
Hospital Revenue Code	250
Min. Negotiated Rate	$3.11
Max. Negotiated Rate	$64.62
Rate for Payer: Aetna Commercial	$49.11
Rate for Payer: Aetna Medicare Advantage	$38.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.96
Rate for Payer: Cigna Commercial	$64.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.77
Rate for Payer: Oxford Commercial	$25.85
Rate for Payer: Qualcare PPO/HMO/WC	$19.39
Rate for Payer: UnitedHealthcare Commercial	$25.85
Rate for Payer: UnitedHealthcare Community & State	$3.11
Rate for Payer: Wellpoint Medicaid Managed Care	$3.42

MANNITOL 50 ML SOL

Facility

$10.10

Hospital Charge Code	6010144R
Hospital Revenue Code	250
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$1.51
Rate for Payer: Qualcare PPO/HMO/WC	$1.51

MANNITOL 50 ML SOL

Facility

$10.10

Hospital Charge Code	6010144R
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$5.05
Rate for Payer: Aetna Commercial	$3.84
Rate for Payer: Aetna Medicare Advantage	$3.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.58
Rate for Payer: Cigna Commercial	$5.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.03
Rate for Payer: Oxford Commercial	$2.02
Rate for Payer: Qualcare PPO/HMO/WC	$1.51
Rate for Payer: UnitedHealthcare Commercial	$2.02
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

MANNITOL INJ 20% 500ML

Facility

$133.80

Hospital Charge Code	6003396
Hospital Revenue Code	250
Min. Negotiated Rate	$3.22
Max. Negotiated Rate	$66.90
Rate for Payer: Aetna Commercial	$50.84
Rate for Payer: Aetna Medicare Advantage	$40.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.12
Rate for Payer: Cigna Commercial	$66.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.14
Rate for Payer: Oxford Commercial	$26.76
Rate for Payer: Qualcare PPO/HMO/WC	$20.07
Rate for Payer: UnitedHealthcare Commercial	$26.76
Rate for Payer: UnitedHealthcare Community & State	$3.22
Rate for Payer: Wellpoint Medicaid Managed Care	$3.55

MANNITOL INJ 20% 500ML

Facility

$133.80

Hospital Charge Code	6003396
Hospital Revenue Code	250
Min. Negotiated Rate	$20.07
Max. Negotiated Rate	$20.07
Rate for Payer: Qualcare PPO/HMO/WC	$20.07

Mannitol/Sorbitol 3000ml

Facility

$105.32

Service Code	NDC 990798108
Hospital Charge Code	606361019
Hospital Revenue Code	250
Min. Negotiated Rate	$2.54
Max. Negotiated Rate	$52.66
Rate for Payer: Aetna Commercial	$40.02
Rate for Payer: Aetna Medicare Advantage	$31.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.86
Rate for Payer: Cigna Commercial	$52.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.60
Rate for Payer: Oxford Commercial	$21.06
Rate for Payer: Qualcare PPO/HMO/WC	$15.80
Rate for Payer: UnitedHealthcare Commercial	$21.06
Rate for Payer: UnitedHealthcare Community & State	$2.54
Rate for Payer: Wellpoint Medicaid Managed Care	$2.79

Mannitol/Sorbitol 3000ml

Facility

$105.32

Service Code	NDC 990798108
Hospital Charge Code	606361019
Hospital Revenue Code	250
Min. Negotiated Rate	$15.80
Max. Negotiated Rate	$15.80
Rate for Payer: Qualcare PPO/HMO/WC	$15.80

MANOMETER FOR CUFF

Facility

$167.00

Hospital Charge Code	270665164
Hospital Revenue Code	270
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$83.50
Rate for Payer: Aetna Commercial	$63.46
Rate for Payer: Aetna Medicare Advantage	$50.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.59
Rate for Payer: Cigna Commercial	$83.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.10
Rate for Payer: Oxford Commercial	$33.40
Rate for Payer: Qualcare PPO/HMO/WC	$25.05
Rate for Payer: UnitedHealthcare Commercial	$33.40
Rate for Payer: UnitedHealthcare Community & State	$4.02
Rate for Payer: Wellpoint Medicaid Managed Care	$4.43

MANOMETER FOR CUFF

Facility

$167.00

Hospital Charge Code	270665164
Hospital Revenue Code	270
Min. Negotiated Rate	$25.05
Max. Negotiated Rate	$25.05
Rate for Payer: Qualcare PPO/HMO/WC	$25.05

MAN ROADRUNNER EXTRA SUPPORT

Facility

$612.50

Hospital Charge Code	270660263
Hospital Revenue Code	272
Min. Negotiated Rate	$91.88
Max. Negotiated Rate	$91.88
Rate for Payer: Qualcare PPO/HMO/WC	$91.88

MAN ROADRUNNER EXTRA SUPPORT

Facility

$612.50

Hospital Charge Code	270660263
Hospital Revenue Code	272
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$306.25
Rate for Payer: Aetna Commercial	$232.75
Rate for Payer: Aetna Medicare Advantage	$183.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$156.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$156.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$156.19
Rate for Payer: Cigna Commercial	$306.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.75
Rate for Payer: Oxford Commercial	$122.50
Rate for Payer: Qualcare PPO/HMO/WC	$91.88
Rate for Payer: UnitedHealthcare Commercial	$122.50
Rate for Payer: UnitedHealthcare Community & State	$14.76
Rate for Payer: Wellpoint Medicaid Managed Care	$16.23

MANUAL RETIC COUNT

Facility

$57.00

Service Code	HCPCS 85044
Hospital Charge Code	38479051
Hospital Revenue Code	301
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$8.55
Rate for Payer: Qualcare PPO/HMO/WC	$8.55

MANUAL RETIC COUNT

Facility

$57.00

Service Code	HCPCS 85044
Hospital Charge Code	38479051
Hospital Revenue Code	301
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$11.72
Rate for Payer: Aetna Medicare Advantage	$13.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.56
Rate for Payer: Cigna Commercial	$28.50
Rate for Payer: Cigna Medicare Advantage	$4.31
Rate for Payer: Clover Medicare Advantage	$4.09
Rate for Payer: EmblemHealth Commercial	$12.93
Rate for Payer: Humana Medicare Advantage	$4.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.55
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.31
Rate for Payer: Wellcare Medicare Advantage	$4.31
Rate for Payer: Wellpoint Medicaid Managed Care	$1.51

MANUAL THERAPY EA 15 MIN CQ

Facility

$141.65

Service Code	HCPCS 97140GP
Hospital Charge Code	409197140Q
Hospital Revenue Code	420
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$21.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.25

MANUAL THERAPY EA 15 MIN CQ

Facility

$141.65

Service Code	HCPCS 97140GP
Hospital Charge Code	409197140Q
Hospital Revenue Code	420
Min. Negotiated Rate	$3.41
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$53.83
Rate for Payer: Aetna Medicare Advantage	$42.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.12
Rate for Payer: Cigna Commercial	$70.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.49
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.25
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.41
Rate for Payer: Wellpoint Medicaid Managed Care	$3.75

MANUAL THRPY EACH 15 MINUTES

Facility

$142.00

Service Code	HCPCS 97001GP
Hospital Charge Code	1008105
Hospital Revenue Code	420
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.30

Know your out-of-pocket cost for care.

All Charges