Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MICAFUNGIN 100 MG IV

Facility

$1,503.48

Service Code	HCPCS J2248
Hospital Charge Code	60629929
Hospital Revenue Code	636
Min. Negotiated Rate	$36.23
Max. Negotiated Rate	$751.74
Rate for Payer: Aetna Commercial	$571.32
Rate for Payer: Aetna Medicare Advantage	$451.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$383.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$383.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$383.39
Rate for Payer: Cigna Commercial	$751.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.84
Rate for Payer: Qualcare PPO/HMO/WC	$225.52
Rate for Payer: UnitedHealthcare Community & State	$36.23
Rate for Payer: Wellpoint Medicaid Managed Care	$39.84

MICAFUNGIN 100 MG IV

Facility

$1,503.48

Service Code	HCPCS J2248
Hospital Charge Code	60629929
Hospital Revenue Code	636
Min. Negotiated Rate	$225.52
Max. Negotiated Rate	$363.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.84
Rate for Payer: Qualcare PPO/HMO/WC	$225.52

MICAFUNGIN SODIUM 50 MG VIAL

Facility

$751.74

Service Code	HCPCS J2248
Hospital Charge Code	60629930
Hospital Revenue Code	636
Min. Negotiated Rate	$112.76
Max. Negotiated Rate	$181.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.92
Rate for Payer: Qualcare PPO/HMO/WC	$112.76

MICAFUNGIN SODIUM 50 MG VIAL

Facility

$751.74

Service Code	HCPCS J2248
Hospital Charge Code	60629930
Hospital Revenue Code	636
Min. Negotiated Rate	$18.12
Max. Negotiated Rate	$375.87
Rate for Payer: Aetna Commercial	$285.66
Rate for Payer: Aetna Medicare Advantage	$225.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.69
Rate for Payer: Cigna Commercial	$375.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.92
Rate for Payer: Qualcare PPO/HMO/WC	$112.76
Rate for Payer: UnitedHealthcare Community & State	$18.12
Rate for Payer: Wellpoint Medicaid Managed Care	$19.92

MICA PROSTEP SOLO GUIDE

Facility

$9,656.25

Hospital Charge Code	270703201
Hospital Revenue Code	270
Min. Negotiated Rate	$232.72
Max. Negotiated Rate	$4,828.12
Rate for Payer: Aetna Commercial	$3,669.38
Rate for Payer: Aetna Medicare Advantage	$2,896.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,462.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,462.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,462.34
Rate for Payer: Cigna Commercial	$4,828.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,896.88
Rate for Payer: Oxford Commercial	$1,931.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,448.44
Rate for Payer: UnitedHealthcare Commercial	$1,931.25
Rate for Payer: UnitedHealthcare Community & State	$232.72
Rate for Payer: Wellpoint Medicaid Managed Care	$255.89

MICA PROSTEP SOLO GUIDE

Facility

$9,656.25

Hospital Charge Code	270703201
Hospital Revenue Code	270
Min. Negotiated Rate	$1,448.44
Max. Negotiated Rate	$1,448.44
Rate for Payer: Qualcare PPO/HMO/WC	$1,448.44

MICA SCREW

Facility

$2,860.00

Hospital Charge Code	270703200
Hospital Revenue Code	278
Min. Negotiated Rate	$68.93
Max. Negotiated Rate	$1,430.00
Rate for Payer: Aetna Commercial	$1,086.80
Rate for Payer: Aetna Medicare Advantage	$858.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$729.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$729.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$572.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$729.30
Rate for Payer: Cigna Commercial	$1,430.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$692.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$629.20
Rate for Payer: Qualcare PPO/HMO/WC	$429.00
Rate for Payer: UnitedHealthcare Community & State	$68.93
Rate for Payer: Wellpoint Medicaid Managed Care	$75.79

MICA SCREW

Facility

$2,860.00

Hospital Charge Code	270703200
Hospital Revenue Code	278
Min. Negotiated Rate	$429.00
Max. Negotiated Rate	$692.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$572.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$692.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$629.20
Rate for Payer: Qualcare PPO/HMO/WC	$429.00

MICA SCREW 4X60MM

Facility

$2,845.25

Hospital Charge Code	270702620
Hospital Revenue Code	278
Min. Negotiated Rate	$426.79
Max. Negotiated Rate	$688.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$625.96
Rate for Payer: Qualcare PPO/HMO/WC	$426.79

MICA SCREW 4X60MM

Facility

$2,845.25

Hospital Charge Code	270702620
Hospital Revenue Code	278
Min. Negotiated Rate	$68.57
Max. Negotiated Rate	$1,422.62
Rate for Payer: Aetna Commercial	$1,081.19
Rate for Payer: Aetna Medicare Advantage	$853.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$725.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$725.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$725.54
Rate for Payer: Cigna Commercial	$1,422.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$625.96
Rate for Payer: Qualcare PPO/HMO/WC	$426.79
Rate for Payer: UnitedHealthcare Community & State	$68.57
Rate for Payer: Wellpoint Medicaid Managed Care	$75.40

MICONAZALE CRM TOP 2% 15GM

Facility

$109.45

Hospital Charge Code	6009187
Hospital Revenue Code	251
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$54.73
Rate for Payer: Aetna Commercial	$41.59
Rate for Payer: Aetna Medicare Advantage	$32.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.91
Rate for Payer: Cigna Commercial	$54.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.84
Rate for Payer: Oxford Commercial	$21.89
Rate for Payer: Qualcare PPO/HMO/WC	$16.42
Rate for Payer: UnitedHealthcare Commercial	$21.89
Rate for Payer: UnitedHealthcare Community & State	$2.64
Rate for Payer: Wellpoint Medicaid Managed Care	$2.90

MICONAZALE CRM TOP 2% 15GM

Facility

$109.45

Hospital Charge Code	6009187
Hospital Revenue Code	251
Min. Negotiated Rate	$16.42
Max. Negotiated Rate	$16.42
Rate for Payer: Qualcare PPO/HMO/WC	$16.42

MICONAZOLE CRM 2% 28GM

Facility

$136.35

Hospital Charge Code	6003727
Hospital Revenue Code	251
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$68.17
Rate for Payer: Aetna Commercial	$51.81
Rate for Payer: Aetna Medicare Advantage	$40.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.77
Rate for Payer: Cigna Commercial	$68.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.91
Rate for Payer: Oxford Commercial	$27.27
Rate for Payer: Qualcare PPO/HMO/WC	$20.45
Rate for Payer: UnitedHealthcare Commercial	$27.27
Rate for Payer: UnitedHealthcare Community & State	$3.29
Rate for Payer: Wellpoint Medicaid Managed Care	$3.61

MICONAZOLE CRM 2% 28GM

Facility

$136.35

Hospital Charge Code	6003727
Hospital Revenue Code	251
Min. Negotiated Rate	$20.45
Max. Negotiated Rate	$20.45
Rate for Payer: Qualcare PPO/HMO/WC	$20.45

MICONAZOLE NITRATE 100 MG SUP

Facility

$6.23

Service Code	NDC 713019757
Hospital Charge Code	60628340
Hospital Revenue Code	250
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$0.93
Rate for Payer: Qualcare PPO/HMO/WC	$0.93

MICONAZOLE NITRATE 100 MG SUP

Facility

$6.23

Service Code	NDC 713019757
Hospital Charge Code	60628340
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$3.12
Rate for Payer: Aetna Commercial	$2.37
Rate for Payer: Aetna Medicare Advantage	$1.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.59
Rate for Payer: Cigna Commercial	$3.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.87
Rate for Payer: Oxford Commercial	$1.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.93
Rate for Payer: UnitedHealthcare Commercial	$1.25
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

MICONAZOLE NITRATE 2% CREAM

Facility

$49.18

Service Code	NDC 603780550
Hospital Charge Code	60628341
Hospital Revenue Code	250
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$24.59
Rate for Payer: Aetna Commercial	$18.69
Rate for Payer: Aetna Medicare Advantage	$14.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.54
Rate for Payer: Cigna Commercial	$24.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.75
Rate for Payer: Oxford Commercial	$9.84
Rate for Payer: Qualcare PPO/HMO/WC	$7.38
Rate for Payer: UnitedHealthcare Commercial	$9.84
Rate for Payer: UnitedHealthcare Community & State	$1.19
Rate for Payer: Wellpoint Medicaid Managed Care	$1.30

MICONAZOLE NITRATE 2% CREAM

Facility

$49.18

Service Code	NDC 603780550
Hospital Charge Code	60628341
Hospital Revenue Code	250
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$7.38
Rate for Payer: Qualcare PPO/HMO/WC	$7.38

MICONAZOLE NITRATE 45 GM CRE

Facility

$78.99

Service Code	NDC 904773445
Hospital Charge Code	6009179
Hospital Revenue Code	251
Min. Negotiated Rate	$11.85
Max. Negotiated Rate	$11.85
Rate for Payer: Qualcare PPO/HMO/WC	$11.85

MICONAZOLE NITRATE 45 GM CRE

Facility

$78.99

Service Code	NDC 904773445
Hospital Charge Code	6009179
Hospital Revenue Code	251
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$39.49
Rate for Payer: Aetna Commercial	$30.02
Rate for Payer: Aetna Medicare Advantage	$23.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.14
Rate for Payer: Cigna Commercial	$39.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.70
Rate for Payer: Oxford Commercial	$15.80
Rate for Payer: Qualcare PPO/HMO/WC	$11.85
Rate for Payer: UnitedHealthcare Commercial	$15.80
Rate for Payer: UnitedHealthcare Community & State	$1.90
Rate for Payer: Wellpoint Medicaid Managed Care	$2.09

MICONAZOLE VAG CRM 2% 45GM

Facility

$142.75

Hospital Charge Code	6003743
Hospital Revenue Code	251
Min. Negotiated Rate	$21.41
Max. Negotiated Rate	$21.41
Rate for Payer: Qualcare PPO/HMO/WC	$21.41

MICONAZOLE VAG CRM 2% 45GM

Facility

$142.75

Hospital Charge Code	6003743
Hospital Revenue Code	251
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$71.38
Rate for Payer: Aetna Commercial	$54.24
Rate for Payer: Aetna Medicare Advantage	$42.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.40
Rate for Payer: Cigna Commercial	$71.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.83
Rate for Payer: Oxford Commercial	$28.55
Rate for Payer: Qualcare PPO/HMO/WC	$21.41
Rate for Payer: UnitedHealthcare Commercial	$28.55
Rate for Payer: UnitedHealthcare Community & State	$3.44
Rate for Payer: Wellpoint Medicaid Managed Care	$3.78

MICONAZOLE VAG SUPP

Facility

$152.35

Hospital Charge Code	6003735
Hospital Revenue Code	251
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$76.17
Rate for Payer: Aetna Commercial	$57.89
Rate for Payer: Aetna Medicare Advantage	$45.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.85
Rate for Payer: Cigna Commercial	$76.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.70
Rate for Payer: Oxford Commercial	$30.47
Rate for Payer: Qualcare PPO/HMO/WC	$22.85
Rate for Payer: UnitedHealthcare Commercial	$30.47
Rate for Payer: UnitedHealthcare Community & State	$3.67
Rate for Payer: Wellpoint Medicaid Managed Care	$4.04

MICONAZOLE VAG SUPP

Facility

$152.35

Hospital Charge Code	6003735
Hospital Revenue Code	251
Min. Negotiated Rate	$22.85
Max. Negotiated Rate	$22.85
Rate for Payer: Qualcare PPO/HMO/WC	$22.85

MICONAZOLE VAG SUPP 100MG

Facility

$19.85

Hospital Charge Code	6008957
Hospital Revenue Code	251
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$9.93
Rate for Payer: Aetna Commercial	$7.54
Rate for Payer: Aetna Medicare Advantage	$5.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.06
Rate for Payer: Cigna Commercial	$9.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.96
Rate for Payer: Oxford Commercial	$3.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.98
Rate for Payer: UnitedHealthcare Commercial	$3.97
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

Know your out-of-pocket cost for care.

All Charges