Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MEZLOCILLIN INJ 3GM

Facility

$83.85

Hospital Charge Code	6007611
Hospital Revenue Code	250
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$41.92
Rate for Payer: Aetna Commercial	$31.86
Rate for Payer: Aetna Medicare Advantage	$25.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.38
Rate for Payer: Cigna Commercial	$41.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.16
Rate for Payer: Oxford Commercial	$16.77
Rate for Payer: Qualcare PPO/HMO/WC	$12.58
Rate for Payer: UnitedHealthcare Commercial	$16.77
Rate for Payer: UnitedHealthcare Community & State	$2.02
Rate for Payer: Wellpoint Medicaid Managed Care	$2.22

MEZLOCILLIN INJ 4GM

Facility

$104.35

Hospital Charge Code	6007629
Hospital Revenue Code	250
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$52.17
Rate for Payer: Aetna Commercial	$39.65
Rate for Payer: Aetna Medicare Advantage	$31.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.61
Rate for Payer: Cigna Commercial	$52.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.30
Rate for Payer: Oxford Commercial	$20.87
Rate for Payer: Qualcare PPO/HMO/WC	$15.65
Rate for Payer: UnitedHealthcare Commercial	$20.87
Rate for Payer: UnitedHealthcare Community & State	$2.51
Rate for Payer: Wellpoint Medicaid Managed Care	$2.77

MEZLOCILLIN INJ 4GM

Facility

$104.35

Hospital Charge Code	6007629
Hospital Revenue Code	250
Min. Negotiated Rate	$15.65
Max. Negotiated Rate	$15.65
Rate for Payer: Qualcare PPO/HMO/WC	$15.65

MEZLOCILLIN OPH DROPS 100MG/ML

Facility

$946.60

Hospital Charge Code	6003719
Hospital Revenue Code	252
Min. Negotiated Rate	$141.99
Max. Negotiated Rate	$141.99
Rate for Payer: Qualcare PPO/HMO/WC	$141.99

MEZLOCILLIN OPH DROPS 100MG/ML

Facility

$946.60

Hospital Charge Code	60037193
Hospital Revenue Code	250
Min. Negotiated Rate	$141.99
Max. Negotiated Rate	$141.99
Rate for Payer: Qualcare PPO/HMO/WC	$141.99

MEZLOCILLIN OPH DROPS 100MG/ML

Facility

$946.60

Hospital Charge Code	60037193
Hospital Revenue Code	250
Min. Negotiated Rate	$22.81
Max. Negotiated Rate	$473.30
Rate for Payer: Aetna Commercial	$359.71
Rate for Payer: Aetna Medicare Advantage	$283.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$241.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$241.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$241.38
Rate for Payer: Cigna Commercial	$473.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$283.98
Rate for Payer: Oxford Commercial	$189.32
Rate for Payer: Qualcare PPO/HMO/WC	$141.99
Rate for Payer: UnitedHealthcare Commercial	$189.32
Rate for Payer: UnitedHealthcare Community & State	$22.81
Rate for Payer: Wellpoint Medicaid Managed Care	$25.08

MEZLOCILLIN OPH DROPS 100MG/ML

Facility

$946.60

Hospital Charge Code	6003719
Hospital Revenue Code	252
Min. Negotiated Rate	$22.81
Max. Negotiated Rate	$473.30
Rate for Payer: Aetna Commercial	$359.71
Rate for Payer: Aetna Medicare Advantage	$283.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$241.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$241.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$241.38
Rate for Payer: Cigna Commercial	$473.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$283.98
Rate for Payer: Oxford Commercial	$189.32
Rate for Payer: Qualcare PPO/HMO/WC	$141.99
Rate for Payer: UnitedHealthcare Commercial	$189.32
Rate for Payer: UnitedHealthcare Community & State	$22.81
Rate for Payer: Wellpoint Medicaid Managed Care	$25.08

MEZLOCILLIN OPH SBCN 100MG/ML

Facility

$485.80

Hospital Charge Code	6003701
Hospital Revenue Code	252
Min. Negotiated Rate	$72.87
Max. Negotiated Rate	$72.87
Rate for Payer: Qualcare PPO/HMO/WC	$72.87

MEZLOCILLIN OPH SBCN 100MG/ML

Facility

$485.80

Hospital Charge Code	6003701
Hospital Revenue Code	252
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$242.90
Rate for Payer: Aetna Commercial	$184.60
Rate for Payer: Aetna Medicare Advantage	$145.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$123.88
Rate for Payer: Cigna Commercial	$242.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.74
Rate for Payer: Oxford Commercial	$97.16
Rate for Payer: Qualcare PPO/HMO/WC	$72.87
Rate for Payer: UnitedHealthcare Commercial	$97.16
Rate for Payer: UnitedHealthcare Community & State	$11.71
Rate for Payer: Wellpoint Medicaid Managed Care	$12.87

MG-ALUM/SIMETH SUSP 30ML(MYLAN

Facility

$2.00

Hospital Charge Code	83652577
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.40
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

MG-ALUM/SIMETH SUSP 30ML(MYLAN

Facility

$2.00

Hospital Charge Code	83652577
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

M.GENITALIUM AMP PROBE URINE V

Facility

$173.23

Service Code	HCPCS 87563
Hospital Charge Code	401387563
Hospital Revenue Code	306
Min. Negotiated Rate	$25.98
Max. Negotiated Rate	$25.98
Rate for Payer: Qualcare PPO/HMO/WC	$25.98

M.GENITALIUM AMP PROBE URINE V

Facility

$173.23

Service Code	HCPCS 87563
Hospital Charge Code	401387563
Hospital Revenue Code	306
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$126.66
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$86.61
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.98
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$4.59

MHA-TP

Facility

$141.65

Service Code	HCPCS 86780
Hospital Charge Code	3001350
Hospital Revenue Code	302
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$36.01
Rate for Payer: Aetna Medicare Advantage	$42.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.79
Rate for Payer: Cigna Commercial	$70.83
Rate for Payer: Cigna Medicare Advantage	$13.24
Rate for Payer: Clover Medicare Advantage	$12.58
Rate for Payer: EmblemHealth Commercial	$39.72
Rate for Payer: Humana Medicare Advantage	$13.64
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.24
Rate for Payer: Wellcare Medicare Advantage	$13.24
Rate for Payer: Wellpoint Medicaid Managed Care	$3.75

MHA-TP

Facility

$141.65

Service Code	HCPCS 86780
Hospital Charge Code	3001350
Hospital Revenue Code	302
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$21.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.25

M.HOMINIS/UREAPLASMA CULT

Facility

$390.00

Service Code	HCPCS 87109
Hospital Charge Code	39900490
Hospital Revenue Code	309
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$41.86
Rate for Payer: Aetna Medicare Advantage	$49.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.55
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$15.39
Rate for Payer: Clover Medicare Advantage	$14.62
Rate for Payer: EmblemHealth Commercial	$46.17
Rate for Payer: Humana Medicare Advantage	$15.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.39
Rate for Payer: Wellcare Medicare Advantage	$15.39
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

M.HOMINIS/UREAPLASMA CULT

Facility

$390.00

Service Code	HCPCS 87109
Hospital Charge Code	39900490
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

M.HOMINIS/UREAPLASMA CULT

Facility

$105.75

Service Code	HCPCS 87109
Hospital Charge Code	39900268
Hospital Revenue Code	309
Min. Negotiated Rate	$15.86
Max. Negotiated Rate	$15.86
Rate for Payer: Qualcare PPO/HMO/WC	$15.86

M.HOMINIS/UREAPLASMA CULT

Facility

$105.75

Service Code	HCPCS 87109
Hospital Charge Code	39900268
Hospital Revenue Code	309
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$41.86
Rate for Payer: Aetna Medicare Advantage	$49.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.55
Rate for Payer: Cigna Commercial	$52.88
Rate for Payer: Cigna Medicare Advantage	$15.39
Rate for Payer: Clover Medicare Advantage	$14.62
Rate for Payer: EmblemHealth Commercial	$46.17
Rate for Payer: Humana Medicare Advantage	$15.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.73
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.86
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.39
Rate for Payer: Wellcare Medicare Advantage	$15.39
Rate for Payer: Wellpoint Medicaid Managed Care	$2.80

MIC

Facility

$160.00

Service Code	HCPCS 87186
Hospital Charge Code	38475074
Hospital Revenue Code	309
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00

MIC

Facility

$160.00

Service Code	HCPCS 87186
Hospital Charge Code	38475074
Hospital Revenue Code	309
Min. Negotiated Rate	$4.24
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$23.53
Rate for Payer: Aetna Medicare Advantage	$28.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.22
Rate for Payer: Cigna Commercial	$80.00
Rate for Payer: Cigna Medicare Advantage	$8.65
Rate for Payer: Clover Medicare Advantage	$8.22
Rate for Payer: EmblemHealth Commercial	$25.95
Rate for Payer: Humana Medicare Advantage	$8.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.65
Rate for Payer: Wellcare Medicare Advantage	$8.65
Rate for Payer: Wellpoint Medicaid Managed Care	$4.24

MICA DEPTH GAUGE 150 STER MICA

Facility

$558.00

Service Code	HCPCS C1713
Hospital Charge Code	270702606
Hospital Revenue Code	278
Min. Negotiated Rate	$83.70
Max. Negotiated Rate	$135.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$111.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$122.76
Rate for Payer: Qualcare PPO/HMO/WC	$83.70

MICA DEPTH GAUGE 150 STER MICA

Facility

$558.00

Service Code	HCPCS C1713
Hospital Charge Code	270702606
Hospital Revenue Code	278
Min. Negotiated Rate	$13.45
Max. Negotiated Rate	$279.00
Rate for Payer: Aetna Commercial	$212.04
Rate for Payer: Aetna Medicare Advantage	$167.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$111.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$142.29
Rate for Payer: Cigna Commercial	$279.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$122.76
Rate for Payer: Qualcare PPO/HMO/WC	$83.70
Rate for Payer: UnitedHealthcare Community & State	$13.45
Rate for Payer: Wellpoint Medicaid Managed Care	$14.79

MICA FIRST MET TRANSL STER MIC

Facility

$567.00

Service Code	HCPCS C1713
Hospital Charge Code	270702610
Hospital Revenue Code	278
Min. Negotiated Rate	$13.66
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna Commercial	$215.46
Rate for Payer: Aetna Medicare Advantage	$170.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$113.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.59
Rate for Payer: Cigna Commercial	$283.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$124.74
Rate for Payer: Qualcare PPO/HMO/WC	$85.05
Rate for Payer: UnitedHealthcare Community & State	$13.66
Rate for Payer: Wellpoint Medicaid Managed Care	$15.03

MICA FIRST MET TRANSL STER MIC

Facility

$567.00

Service Code	HCPCS C1713
Hospital Charge Code	270702610
Hospital Revenue Code	278
Min. Negotiated Rate	$85.05
Max. Negotiated Rate	$137.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$113.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$124.74
Rate for Payer: Qualcare PPO/HMO/WC	$85.05

Know your out-of-pocket cost for care.

All Charges