Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MELLARIL/25MG/TAB

Facility

$4.00

Hospital Charge Code	60633370
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

MELLARIL/30MG/1ML

Facility

$135.00

Hospital Charge Code	60633374
Hospital Revenue Code	250
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna Medicare Advantage	$40.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.42
Rate for Payer: Cigna Commercial	$67.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.50
Rate for Payer: Oxford Commercial	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.25
Rate for Payer: UnitedHealthcare Commercial	$27.00
Rate for Payer: UnitedHealthcare Community & State	$3.25
Rate for Payer: Wellpoint Medicaid Managed Care	$3.58

MELLARIL/30MG/1ML

Facility

$135.00

Hospital Charge Code	60633374
Hospital Revenue Code	250
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$20.25
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

MELLARIL/50MG/TAB

Facility

$3.00

Hospital Charge Code	60633372
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

MELLARIL/50MG/TAB

Facility

$3.00

Hospital Charge Code	60633372
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

MELLARIL SUSPENSION/30CC

Facility

$17.00

Hospital Charge Code	60634803
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$8.50
Rate for Payer: Aetna Commercial	$6.46
Rate for Payer: Aetna Medicare Advantage	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.33
Rate for Payer: Cigna Commercial	$8.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.10
Rate for Payer: Oxford Commercial	$3.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.55
Rate for Payer: UnitedHealthcare Commercial	$3.40
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

MELLARIL SUSPENSION/30CC

Facility

$17.00

Hospital Charge Code	60634803
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.55
Rate for Payer: Qualcare PPO/HMO/WC	$2.55

MELPHADAN HYDROCHL/50ML

Facility

$1,577.00

Hospital Charge Code	60634985
Hospital Revenue Code	636
Min. Negotiated Rate	$236.55
Max. Negotiated Rate	$381.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$381.63
Rate for Payer: Qualcare PPO/HMO/WC	$236.55

MELPHADAN HYDROCHL/50ML

Facility

$1,577.00

Hospital Charge Code	60634985
Hospital Revenue Code	636
Min. Negotiated Rate	$38.01
Max. Negotiated Rate	$788.50
Rate for Payer: Aetna Commercial	$599.26
Rate for Payer: Aetna Medicare Advantage	$473.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$402.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$402.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$402.13
Rate for Payer: Cigna Commercial	$788.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$381.63
Rate for Payer: Qualcare PPO/HMO/WC	$236.55
Rate for Payer: UnitedHealthcare Community & State	$38.01
Rate for Payer: Wellpoint Medicaid Managed Care	$41.79

MELPHALAN 2/MG

Facility

$5.00

Hospital Charge Code	60632418
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

MELPHALAN 2/MG

Facility

$5.00

Hospital Charge Code	60632418
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

MELPHALAN INJ 50MG

Facility

$1,749.15

Hospital Charge Code	60627395
Hospital Revenue Code	636
Min. Negotiated Rate	$262.37
Max. Negotiated Rate	$423.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.29
Rate for Payer: Qualcare PPO/HMO/WC	$262.37

MELPHALAN INJ 50MG

Facility

$1,749.15

Hospital Charge Code	60627395
Hospital Revenue Code	636
Min. Negotiated Rate	$42.15
Max. Negotiated Rate	$874.58
Rate for Payer: Aetna Commercial	$664.68
Rate for Payer: Aetna Medicare Advantage	$524.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.03
Rate for Payer: Cigna Commercial	$874.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.29
Rate for Payer: Qualcare PPO/HMO/WC	$262.37
Rate for Payer: UnitedHealthcare Community & State	$42.15
Rate for Payer: Wellpoint Medicaid Managed Care	$46.35

MELPHALAN TAB 2MG

Facility

$17.95

Hospital Charge Code	6009799
Hospital Revenue Code	251
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$8.97
Rate for Payer: Aetna Commercial	$6.82
Rate for Payer: Aetna Medicare Advantage	$5.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.58
Rate for Payer: Cigna Commercial	$8.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.38
Rate for Payer: Oxford Commercial	$3.59
Rate for Payer: Qualcare PPO/HMO/WC	$2.69
Rate for Payer: UnitedHealthcare Commercial	$3.59
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

MELPHALAN TAB 2MG

Facility

$17.95

Hospital Charge Code	6009799
Hospital Revenue Code	251
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$2.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.69

MELPHALAN TAB 2MG

Facility

$81.81

Service Code	HCPCS J8600
Hospital Charge Code	60627394
Hospital Revenue Code	636
Min. Negotiated Rate	$12.27
Max. Negotiated Rate	$19.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.80
Rate for Payer: Qualcare PPO/HMO/WC	$12.27

MELPHALAN TAB 2MG

Facility

$81.81

Service Code	HCPCS J8600
Hospital Charge Code	60627394
Hospital Revenue Code	636
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$40.91
Rate for Payer: Aetna Commercial	$31.09
Rate for Payer: Aetna Medicare Advantage	$24.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.86
Rate for Payer: Cigna Commercial	$40.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.80
Rate for Payer: Qualcare PPO/HMO/WC	$12.27
Rate for Payer: UnitedHealthcare Community & State	$1.97
Rate for Payer: Wellpoint Medicaid Managed Care	$2.17

MEMANTINE 10MG

Facility

$41.88

Service Code	NDC 456321063
Hospital Charge Code	60629833
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$20.94
Rate for Payer: Aetna Commercial	$15.91
Rate for Payer: Aetna Medicare Advantage	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.68
Rate for Payer: Cigna Commercial	$20.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.56
Rate for Payer: Oxford Commercial	$8.38
Rate for Payer: Qualcare PPO/HMO/WC	$6.28
Rate for Payer: UnitedHealthcare Commercial	$8.38
Rate for Payer: UnitedHealthcare Community & State	$1.01
Rate for Payer: Wellpoint Medicaid Managed Care	$1.11

MEMANTINE 10MG

Facility

$41.88

Service Code	NDC 456321063
Hospital Charge Code	60629833
Hospital Revenue Code	250
Min. Negotiated Rate	$6.28
Max. Negotiated Rate	$6.28
Rate for Payer: Qualcare PPO/HMO/WC	$6.28

MEMANTINE 5MG TAB UD

Facility

$41.88

Service Code	NDC 456320563
Hospital Charge Code	60629854
Hospital Revenue Code	250
Min. Negotiated Rate	$6.28
Max. Negotiated Rate	$6.28
Rate for Payer: Qualcare PPO/HMO/WC	$6.28

MEMANTINE 5MG TAB UD

Facility

$41.88

Service Code	NDC 456320563
Hospital Charge Code	60629854
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$20.94
Rate for Payer: Aetna Commercial	$15.91
Rate for Payer: Aetna Medicare Advantage	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.68
Rate for Payer: Cigna Commercial	$20.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.56
Rate for Payer: Oxford Commercial	$8.38
Rate for Payer: Qualcare PPO/HMO/WC	$6.28
Rate for Payer: UnitedHealthcare Commercial	$8.38
Rate for Payer: UnitedHealthcare Community & State	$1.01
Rate for Payer: Wellpoint Medicaid Managed Care	$1.11

MEMBRANE AMNIOTIC 1.4X2CM

Facility

$2,875.00

Hospital Charge Code	270647386
Hospital Revenue Code	278
Min. Negotiated Rate	$431.25
Max. Negotiated Rate	$695.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$695.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$632.50
Rate for Payer: Qualcare PPO/HMO/WC	$431.25

MEMBRANE AMNIOTIC 1.4X2CM

Facility

$2,875.00

Hospital Charge Code	270647386
Hospital Revenue Code	278
Min. Negotiated Rate	$69.29
Max. Negotiated Rate	$1,437.50
Rate for Payer: Aetna Commercial	$1,092.50
Rate for Payer: Aetna Medicare Advantage	$862.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$733.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$733.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$733.12
Rate for Payer: Cigna Commercial	$1,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$695.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$632.50
Rate for Payer: Qualcare PPO/HMO/WC	$431.25
Rate for Payer: UnitedHealthcare Community & State	$69.29
Rate for Payer: Wellpoint Medicaid Managed Care	$76.19

MEMBRANE PALIN GEN FLOW 1ML

Facility

$13,875.00

Hospital Charge Code	270676393
Hospital Revenue Code	272
Min. Negotiated Rate	$334.39
Max. Negotiated Rate	$6,937.50
Rate for Payer: Aetna Commercial	$5,272.50
Rate for Payer: Aetna Medicare Advantage	$4,162.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,538.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,538.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,538.12
Rate for Payer: Cigna Commercial	$6,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,162.50
Rate for Payer: Oxford Commercial	$2,775.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,081.25
Rate for Payer: UnitedHealthcare Commercial	$2,775.00
Rate for Payer: UnitedHealthcare Community & State	$334.39
Rate for Payer: Wellpoint Medicaid Managed Care	$367.69

MEMBRANE PALIN GEN FLOW 1ML

Facility

$13,875.00

Hospital Charge Code	270676393
Hospital Revenue Code	272
Min. Negotiated Rate	$2,081.25
Max. Negotiated Rate	$2,081.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,081.25

Know your out-of-pocket cost for care.

All Charges