Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MED MNG CHILD/15MIN PH MCAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4510628
Hospital Revenue Code	919
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: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

MED MNG CHILD/15MIN PH MCAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4822628
Hospital Revenue Code	919
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

MED MNG CHILD/15MIN PH MCAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4509628
Hospital Revenue Code	919
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: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

MED MNG CHILD/15MIN PH MCAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4510628
Hospital Revenue Code	919
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

MED MNG CHILD/15MIN PH MCAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4824628
Hospital Revenue Code	919
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

MED MNG CHILD/15MIN PH MCAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4509628
Hospital Revenue Code	919
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

MED ROCKER SHOE

Facility

$6,644.50

Hospital Charge Code	270702659
Hospital Revenue Code	275
Min. Negotiated Rate	$996.67
Max. Negotiated Rate	$1,607.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,328.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,607.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,461.79
Rate for Payer: Qualcare PPO/HMO/WC	$996.67

MED ROCKER SHOE

Facility

$6,644.50

Hospital Charge Code	270702659
Hospital Revenue Code	275
Min. Negotiated Rate	$160.13
Max. Negotiated Rate	$3,322.25
Rate for Payer: Aetna Commercial	$2,524.91
Rate for Payer: Aetna Medicare Advantage	$1,993.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,694.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,694.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,328.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,694.35
Rate for Payer: Cigna Commercial	$3,322.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,607.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,461.79
Rate for Payer: Qualcare PPO/HMO/WC	$996.67
Rate for Payer: UnitedHealthcare Community & State	$160.13
Rate for Payer: Wellpoint Medicaid Managed Care	$176.08

MEDROL/4MG/TAB

Facility

$5.00

Hospital Charge Code	60633364
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

MEDROL/4MG/TAB

Facility

$5.00

Hospital Charge Code	60633364
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

MEDROL DOSEPAK/4MG/TAB

Facility

$66.00

Hospital Charge Code	60633365
Hospital Revenue Code	250
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$25.08
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.80
Rate for Payer: Oxford Commercial	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$13.20
Rate for Payer: UnitedHealthcare Community & State	$1.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1.75

MEDROL DOSEPAK/4MG/TAB

Facility

$66.00

Hospital Charge Code	60633365
Hospital Revenue Code	250
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

MEDRONATE MDP KIT

Facility

$63.00

Hospital Charge Code	270658200
Hospital Revenue Code	270
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$9.45
Rate for Payer: Qualcare PPO/HMO/WC	$9.45

MEDRONATE MDP KIT

Facility

$63.00

Hospital Charge Code	270658200
Hospital Revenue Code	270
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna Commercial	$23.94
Rate for Payer: Aetna Medicare Advantage	$18.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.07
Rate for Payer: Cigna Commercial	$31.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.90
Rate for Payer: Oxford Commercial	$12.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.45
Rate for Payer: UnitedHealthcare Commercial	$12.60
Rate for Payer: UnitedHealthcare Community & State	$1.52
Rate for Payer: Wellpoint Medicaid Managed Care	$1.67

MEDROXY ACE 150 MG/ML

Facility

$1,164.19

Service Code	HCPCS J1050
Hospital Charge Code	60630099
Hospital Revenue Code	636
Min. Negotiated Rate	$28.06
Max. Negotiated Rate	$582.10
Rate for Payer: Aetna Commercial	$442.39
Rate for Payer: Aetna Medicare Advantage	$349.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$296.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$296.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$296.87
Rate for Payer: Cigna Commercial	$582.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.73
Rate for Payer: Qualcare PPO/HMO/WC	$174.63
Rate for Payer: UnitedHealthcare Community & State	$28.06
Rate for Payer: Wellpoint Medicaid Managed Care	$30.85

MEDROXY ACE 150 MG/ML

Facility

$1,164.19

Service Code	HCPCS J1050
Hospital Charge Code	60630099
Hospital Revenue Code	636
Min. Negotiated Rate	$174.63
Max. Negotiated Rate	$281.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.73
Rate for Payer: Qualcare PPO/HMO/WC	$174.63

MEDROXYPROGESTERN INJ 400MG/1M

Facility

$987.25

Hospital Charge Code	60628248
Hospital Revenue Code	636
Min. Negotiated Rate	$23.79
Max. Negotiated Rate	$493.62
Rate for Payer: Aetna Commercial	$375.15
Rate for Payer: Aetna Medicare Advantage	$296.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$251.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$251.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$251.75
Rate for Payer: Cigna Commercial	$493.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.91
Rate for Payer: Qualcare PPO/HMO/WC	$148.09
Rate for Payer: UnitedHealthcare Community & State	$23.79
Rate for Payer: Wellpoint Medicaid Managed Care	$26.16

MEDROXYPROGESTERN INJ 400MG/1M

Facility

$987.25

Hospital Charge Code	60628248
Hospital Revenue Code	636
Min. Negotiated Rate	$148.09
Max. Negotiated Rate	$238.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.91
Rate for Payer: Qualcare PPO/HMO/WC	$148.09

MEDROXYPROGESTERN TAB 10MG

Facility

$4.00

Service Code	NDC 555077902
Hospital Charge Code	60628246
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

MEDROXYPROGESTERN TAB 10MG

Facility

$4.00

Service Code	NDC 555077902
Hospital Charge Code	60628246
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

MEDROXYPROGESTERN TAB 2.5MG

Facility

$11.86

Service Code	NDC 9006501
Hospital Charge Code	60628247
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$5.93
Rate for Payer: Aetna Commercial	$4.51
Rate for Payer: Aetna Medicare Advantage	$3.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.02
Rate for Payer: Cigna Commercial	$5.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.56
Rate for Payer: Oxford Commercial	$2.37
Rate for Payer: Qualcare PPO/HMO/WC	$1.78
Rate for Payer: UnitedHealthcare Commercial	$2.37
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.31

MEDROXYPROGESTERN TAB 2.5MG

Facility

$11.86

Service Code	NDC 9006501
Hospital Charge Code	60628247
Hospital Revenue Code	250
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$1.78
Rate for Payer: Qualcare PPO/HMO/WC	$1.78

MEDROXYPROGESTERONE 5MG TAB

Facility

$17.89

Service Code	NDC 9028701
Hospital Charge Code	6063943131
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$8.95
Rate for Payer: Aetna Commercial	$6.80
Rate for Payer: Aetna Medicare Advantage	$5.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.56
Rate for Payer: Cigna Commercial	$8.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.37
Rate for Payer: Oxford Commercial	$3.58
Rate for Payer: Qualcare PPO/HMO/WC	$2.68
Rate for Payer: UnitedHealthcare Commercial	$3.58
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.47

MEDROXYPROGESTERONE 5MG TAB

Facility

$17.89

Service Code	NDC 9028701
Hospital Charge Code	6063943131
Hospital Revenue Code	250
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$2.68
Rate for Payer: Qualcare PPO/HMO/WC	$2.68

MEDROXYPROGESTERONE ACETA

Facility

$3.00

Hospital Charge Code	60633367
Hospital Revenue Code	636
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	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
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