Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MECLIZINE/25MG/TAB

Facility

$4.00

Hospital Charge Code	60633360
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

MECLIZINE/25MG/TAB

Facility

$3.00

Hospital Charge Code	60633361
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

MECLIZINE TAB 25MG

Facility

$4.00

Service Code	NDC 65162044210
Hospital Charge Code	60628143
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

MECLIZINE TAB 25MG

Facility

$4.00

Service Code	NDC 65162044210
Hospital Charge Code	60628143
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

MECLOFENAMATE CAP 50MG

Facility

$3.85

Hospital Charge Code	60628644
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.46
Rate for Payer: Aetna Medicare Advantage	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.98
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.16
Rate for Payer: Oxford Commercial	$0.77
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Commercial	$0.77
Rate for Payer: UnitedHealthcare Community & State	$0.09
Rate for Payer: Wellpoint Medicaid Managed Care	$0.10

MECLOFENAMATE CAP 50MG

Facility

$3.85

Hospital Charge Code	60628644
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

MECLOMEN/100MG/CAP

Facility

$6.00

Hospital Charge Code	60633363
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

MECLOMEN/100MG/CAP

Facility

$6.00

Hospital Charge Code	60633363
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

MED CAGE H14 10

Facility

$25,000.00

Service Code	HCPCS C1765
Hospital Charge Code	270703621
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

MED CAGE H14 10

Facility

$25,000.00

Service Code	HCPCS C1765
Hospital Charge Code	270703621
Hospital Revenue Code	278
Min. Negotiated Rate	$602.50
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$9,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00
Rate for Payer: UnitedHealthcare Community & State	$602.50
Rate for Payer: Wellpoint Medicaid Managed Care	$662.50

MEDEKAST CAST OR BOOT 4 INCHES

Facility

$175.00

Hospital Charge Code	270639632
Hospital Revenue Code	272
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

MEDEKAST CAST OR BOOT 4 INCHES

Facility

$175.00

Hospital Charge Code	270639632
Hospital Revenue Code	272
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.50
Rate for Payer: Oxford Commercial	$35.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Commercial	$35.00
Rate for Payer: UnitedHealthcare Community & State	$4.22
Rate for Payer: Wellpoint Medicaid Managed Care	$4.64

MEDEKAST KIT W/2 BOOTS 4

Facility

$537.08

Hospital Charge Code	270639682
Hospital Revenue Code	272
Min. Negotiated Rate	$80.56
Max. Negotiated Rate	$80.56
Rate for Payer: Qualcare PPO/HMO/WC	$80.56

MEDEKAST KIT W/2 BOOTS 4

Facility

$537.08

Hospital Charge Code	270639682
Hospital Revenue Code	272
Min. Negotiated Rate	$12.94
Max. Negotiated Rate	$268.54
Rate for Payer: Aetna Commercial	$204.09
Rate for Payer: Aetna Medicare Advantage	$161.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.96
Rate for Payer: Cigna Commercial	$268.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$161.12
Rate for Payer: Oxford Commercial	$107.42
Rate for Payer: Qualcare PPO/HMO/WC	$80.56
Rate for Payer: UnitedHealthcare Commercial	$107.42
Rate for Payer: UnitedHealthcare Community & State	$12.94
Rate for Payer: Wellpoint Medicaid Managed Care	$14.23

MED E KAST ULTRA TCC2ULTR

Facility

$375.00

Hospital Charge Code	270641932
Hospital Revenue Code	270
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

MED E KAST ULTRA TCC2ULTR

Facility

$375.00

Hospital Charge Code	270641932
Hospital Revenue Code	270
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.50
Rate for Payer: Oxford Commercial	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Commercial	$75.00
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

MEDIAL DISTAL TIBIAL PLT 6H LT

Facility

$3,833.60

Hospital Charge Code	270663178
Hospital Revenue Code	270
Min. Negotiated Rate	$575.04
Max. Negotiated Rate	$575.04
Rate for Payer: Qualcare PPO/HMO/WC	$575.04

MEDIAL DISTAL TIBIAL PLT 6H LT

Facility

$3,833.60

Hospital Charge Code	270663178
Hospital Revenue Code	270
Min. Negotiated Rate	$92.39
Max. Negotiated Rate	$1,916.80
Rate for Payer: Aetna Commercial	$1,456.77
Rate for Payer: Aetna Medicare Advantage	$1,150.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$977.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$977.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$977.57
Rate for Payer: Cigna Commercial	$1,916.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,150.08
Rate for Payer: Oxford Commercial	$766.72
Rate for Payer: Qualcare PPO/HMO/WC	$575.04
Rate for Payer: UnitedHealthcare Commercial	$766.72
Rate for Payer: UnitedHealthcare Community & State	$92.39
Rate for Payer: Wellpoint Medicaid Managed Care	$101.59

MEDIAL MENISCUS LEFT

Facility

$21,000.00

Service Code	HCPCS C1762
Hospital Charge Code	270675518
Hospital Revenue Code	278
Min. Negotiated Rate	$3,150.00
Max. Negotiated Rate	$5,082.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,082.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,620.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,150.00

MEDIAL MENISCUS LEFT

Facility

$21,000.00

Service Code	HCPCS C1762
Hospital Charge Code	270675518
Hospital Revenue Code	278
Min. Negotiated Rate	$506.10
Max. Negotiated Rate	$10,500.00
Rate for Payer: Aetna Commercial	$7,980.00
Rate for Payer: Aetna Medicare Advantage	$6,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,355.00
Rate for Payer: Cigna Commercial	$10,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,082.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,620.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,150.00
Rate for Payer: UnitedHealthcare Community & State	$506.10
Rate for Payer: Wellpoint Medicaid Managed Care	$556.50

MEDICAL BACK PROBLEMS WITH MCC

Facility

$56,308.42

Service Code	MSDRG 551
Min. Negotiated Rate	$17,145.19
Max. Negotiated Rate	$56,308.42
Rate for Payer: Aetna Commercial	$38,947.61
Rate for Payer: Aetna Medicare Advantage	$56,308.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39,543.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39,543.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18,047.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39,543.70
Rate for Payer: Cigna Commercial	$31,366.54
Rate for Payer: Cigna Medicare Advantage	$18,047.57
Rate for Payer: Clover Medicare Advantage	$17,145.19
Rate for Payer: EmblemHealth Commercial	$54,142.71
Rate for Payer: Humana Medicare Advantage	$18,589.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18,047.57
Rate for Payer: Oxford Commercial	$22,543.54
Rate for Payer: UnitedHealthcare Commercial	$39,530.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$18,047.57
Rate for Payer: Wellcare Medicare Advantage	$18,047.57

MEDICAL BACK PROBLEMS WITHOUT MCC

Facility

$33,204.88

Service Code	MSDRG 552
Min. Negotiated Rate	$10,110.46
Max. Negotiated Rate	$33,204.88
Rate for Payer: Aetna Commercial	$23,072.87
Rate for Payer: Aetna Medicare Advantage	$33,204.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,563.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,563.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10,642.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22,563.17
Rate for Payer: Cigna Commercial	$17,989.77
Rate for Payer: Cigna Medicare Advantage	$10,642.59
Rate for Payer: Clover Medicare Advantage	$10,110.46
Rate for Payer: EmblemHealth Commercial	$31,927.77
Rate for Payer: Humana Medicare Advantage	$10,961.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10,642.59
Rate for Payer: Oxford Commercial	$12,929.49
Rate for Payer: UnitedHealthcare Commercial	$22,672.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$10,642.59
Rate for Payer: Wellcare Medicare Advantage	$10,642.59

MEDICAL FAMILY PLANNING WHC***

Facility

$25.30

Service Code	HCPCS 99212WF
Hospital Charge Code	9600015
Hospital Revenue Code	519
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$12.65
Rate for Payer: Aetna Commercial	$9.61
Rate for Payer: Aetna Medicare Advantage	$7.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.45
Rate for Payer: Cigna Commercial	$12.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.59
Rate for Payer: Qualcare PPO/HMO/WC	$3.79
Rate for Payer: UnitedHealthcare Community & State	$0.61
Rate for Payer: Wellpoint Medicaid Managed Care	$0.67

MEDICAL FAMILY PLANNING WHC***

Facility

$25.30

Service Code	HCPCS 99212WF
Hospital Charge Code	9600015
Hospital Revenue Code	519
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$3.79
Rate for Payer: Qualcare PPO/HMO/WC	$3.79

MEDICAL FOLLOW UP*****

Facility

$40.00

Service Code	HCPCS 90801
Hospital Charge Code	9300070
Hospital Revenue Code	910
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

Know your out-of-pocket cost for care.

All Charges